MEDICARE: SHELLIE ACOCELLO ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1639326291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLIE ACOCELLO ATC

Provider Business Mailing Address
First Line	:	130 TURTLE CREEK RD
Second Line	:	APT 6
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-6715
Country	:	US
Telephone Number	:	318-455-4637
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 TURTLE CREEK RD
Second Line	:	APT 6
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-6715
Country	:	US
Telephone Number	:	318-455-4637
Fax Number	:

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

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	09/09/2013

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