Healthcare Provider Details

I. General information

NPI: 1699688408
Provider Name (Legal Business Name): ELITE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

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

2745 W LAYTON AVE STE 101
GREENFIELD WI
53221-2651
US

IV. Provider business mailing address

2745 W LAYTON AVE STE 101
GREENFIELD WI
53221-2651
US

V. Phone/Fax

Practice location:
  • Phone: 346-359-9836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SADIA SHOIAB
Title or Position: OWNER
Credential:
Phone: 346-359-9836