Healthcare Provider Details

I. General information

NPI: 1558726562
Provider Name (Legal Business Name): SHELBY ELLER WESOLOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CYPRESS RD
POMPANO BEACH FL
33060-7133
US

IV. Provider business mailing address

311 S CYPRESS RD
POMPANO BEACH FL
33060-7133
US

V. Phone/Fax

Practice location:
  • Phone: 954-781-7248
  • Fax:
Mailing address:
  • Phone: 954-781-7248
  • Fax: 954-781-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9109322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: