Healthcare Provider Details

I. General information

NPI: 1104696533
Provider Name (Legal Business Name): SHELLEY SIKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 NE 28TH RD
BOCA RATON FL
33431-6831
US

IV. Provider business mailing address

438 NE 28TH RD
BOCA RATON FL
33431-6831
US

V. Phone/Fax

Practice location:
  • Phone: 561-403-9554
  • Fax:
Mailing address:
  • Phone: 561-403-9554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: