Healthcare Provider Details

I. General information

NPI: 1144156647
Provider Name (Legal Business Name): SHELBY C THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 ROYAL BIRKDALE CIR
ROCKLEDGE FL
32955-2241
US

IV. Provider business mailing address

1334 ROYAL BIRKDALE CIR
ROCKLEDGE FL
32955-2241
US

V. Phone/Fax

Practice location:
  • Phone: 321-258-0438
  • Fax:
Mailing address:
  • Phone: 321-258-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHELBY RAE CZAGAS
Title or Position: MEMBER
Credential: LCSW
Phone: 321-258-0438