Healthcare Provider Details

I. General information

NPI: 1477283398
Provider Name (Legal Business Name): SHELBY PLOUCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

86 W UNDERWOOD ST # MP41
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5145
  • Fax:
Mailing address:
  • Phone: 321-841-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN35291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: