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General NPI Number Information
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NPI Number | 1083866842
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Entity Type | Organization
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Legal Business Name | RONALD P SHELLEY PA
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 6108 SE FRONT RD
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City | BELLEVIEW
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State | FL
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Zip | 34420-7307
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Country | US
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Telephone | 352-245-2080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 127
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City | BELLEVIEW
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State | FL
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Zip | 34421-0127
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Country | US
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Telephone | 352-245-2080
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONALD P SHELLEY
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Credential | DO
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Telephone | 352-245-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS1648
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License Number State | FL
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