Healthcare Provider Details

I. General information

NPI: 1750861472
Provider Name (Legal Business Name): SHELLY WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 101
ORLANDO FL
32803-1435
US

IV. Provider business mailing address

3100 SW 62ND AVE STE 3109
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 407-236-0006
  • Fax: 407-236-0007
Mailing address:
  • Phone: 305-662-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME137672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: