Healthcare Provider Details

I. General information

NPI: 1366376485
Provider Name (Legal Business Name): ELLEN SHABO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 ULMERTON RD STE B-3
LARGO FL
33771-3530
US

IV. Provider business mailing address

5252 KARLSBURG PL
PALM HARBOR FL
34685-3620
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-9993
  • Fax:
Mailing address:
  • Phone: 727-945-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: