Healthcare Provider Details

I. General information

NPI: 1699703462
Provider Name (Legal Business Name): MELISSA BETH SHELBY ACNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 231
ALTAMONTE SPRINGS FL
32701-5102
US

IV. Provider business mailing address

2940 E. BANNER GATEWAY DRIVE SUITE #450
GILBERT AZ
85234
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5214
  • Fax: 407-303-5215
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-4734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP4131
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR107934
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11032092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: