MEDICARE: MRS. SHELLEY M GILBERT RPA-C

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	363AM0700X	Medical Physician Assistant	TL2725
2	363AM0700X	Medical Physician Assistant	013354	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TL2725	OTHER	SC	SC MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467698621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLEY M GILBERT RPA-C

Provider Business Mailing Address
First Line	:	PO BOX 1209
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-1209
Country	:	US
Telephone Number	:	843-652-8220
Fax Number	:	843-520-8365

Provider Business Practice Location Address
First Line	:	4301 DICK POND RD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6807
Country	:	US
Telephone Number	:	843-652-8100
Fax Number	:	843-652-8122

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

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	04/06/2017

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