Healthcare Provider Details

I. General information

NPI: 1083527873
Provider Name (Legal Business Name): SHELLEDA JEAN PHILIPPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 KUHL AVE
ORLANDO FL
32806-2008
US

IV. Provider business mailing address

2047 HAREBELL LN
OCOEE FL
34761-5733
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-4473
  • Fax:
Mailing address:
  • Phone: 321-960-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number9583002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: