Healthcare Provider Details

I. General information

NPI: 1548484587
Provider Name (Legal Business Name): KELLY MAUREEN SHEA RCPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8636 WINCHESTER DR
JACKSONVILLE FL
32217-4830
US

IV. Provider business mailing address

8636 WINCHESTER DR
JACKSONVILLE FL
32217-4830
US

V. Phone/Fax

Practice location:
  • Phone: 904-739-0807
  • Fax: 904-367-0364
Mailing address:
  • Phone: 904-739-0807
  • Fax: 904-367-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 22538
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: