MEDICARE: DR. SHANELLE LIANN RODRIGUEZ PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	3216-P.A.	PR

General Provider Information

NPI Number	:	1578489050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANELLE LIANN RODRIGUEZ PA

Provider Business Mailing Address
First Line	:	TT20 CALLE 46
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-2642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	TT20 CALLE 46
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-2642
Country	:	US
Telephone Number	:	787-432-7687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2026
Last Update Date	:	06/29/2026

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