Healthcare Provider Details

I. General information

NPI: 1346242039
Provider Name (Legal Business Name): SHELLEY WILLIS NESBITT PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S MAIN ST
BELLE GLADE FL
33430-4911
US

IV. Provider business mailing address

104 RIDGEWOOD AVE
CLEWISTON FL
33440-5114
US

V. Phone/Fax

Practice location:
  • Phone: 561-996-6571
  • Fax: 561-996-6608
Mailing address:
  • Phone: 863-983-0389
  • Fax: 561-996-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 32861
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPS 32861
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS 32861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: