MEDICARE: AMMAL SHELLEH PA

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	363AS0400X	Surgical Physician Assistant	PA9118055	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	SB409	OTHER	FL	MEDICARE HFPSI
3	SB410	OTHER	FL	MEDICARE HFMG

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497439772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMMAL SHELLEH PA

Provider Business Mailing Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 208
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	386-231-3406
Fax Number	:	386-231-3406

Provider Business Practice Location Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 206
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	386-281-3870
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	12/04/2025

Similar Medicare Providers

1528412236 — NATHANIEL OSBORN D.O.
Practice Location Address:

305 MEMORIAL MEDICAL PKWY STE 206
DAYTONA BEACH, FL
32117-5169

Practice Phone: 863-231-4450
Practice Fax: 863-231-4456

1306838545 — CHRISTOPHER ALLEN GROVE MD
Practice Location Address:

305 MEMORIAL MEDICAL PKWY STE 207
DAYTONA BEACH, FL
32117-5169

Practice Phone: 386-231-3414
Practice Fax: 386-231-3488

1306830617 — KIMBERLY LAVITA CLAYTON BROWN MD
Practice Location Address:

305 MEMORIAL MEDICAL PKWY STE 101
DAYTONA BEACH, FL
32117-5169

Practice Phone: 386-231-3615
Practice Fax: 386-231-3614

1346226644 — DR. CARLOS FERNANDEZ-MAYMI M.D.
Practice Location Address:

305 MEMORIAL MEDICAL PKWY STE 405
DAYTONA BEACH, FL
32117-5169

Practice Phone: 989-584-3981
Practice Fax:

1669458600 — DR. PETER J WAKEMAN D.C.
Practice Location Address:

305 MEMORIAL MEDICAL PKWY STE 305
DAYTONA BEACH, FL
32117-5169

Practice Phone: 386-673-0201
Practice Fax: 386-677-8143

1467428318 — GARY M PITTS M.D.
Practice Location Address:

305 MEMORIAL MEDICAL PKWY STE 502
DAYTONA BEACH, FL
32117-5169

Practice Phone: 386-231-3570
Practice Fax: 386-231-3571

Directions to “ AMMAL SHELLEH PA” Practice Location

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