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General NPI Number Information
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NPI Number | 1942472139
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Entity Type | Organization
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Legal Business Name | ROBERT J. SHELLITO DPM, INC.
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 1543 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44483-6639
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Country | US
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Telephone | 330-392-2700
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Fax | 330-392-2707
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | HUBBARD
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State | OH
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Zip | 44425-0070
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Country | US
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Telephone | 330-534-4438
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PODIATRIST
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Name | DR. ROBERT JUDE SHELLITO
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Credential | DPM
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Telephone | 330-534-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC005955
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36003129
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License Number State | OH
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