MEDICARE: SHELBY RIBBINK RDMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085U0001X	Diagnostic Ultrasound Physician	204575	FL

General Provider Information

NPI Number	:	1457218240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY RIBBINK RDMS

Provider Business Mailing Address
First Line	:	4038 S ATLANTIC AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-6641
Country	:	US
Telephone Number	:	386-882-0961
Fax Number	:

Provider Business Practice Location Address
First Line	:	4038 S ATLANTIC AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-6641
Country	:	US
Telephone Number	:	386-882-0961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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