MEDICARE: DR. SHELANE ALEXIS JENKINS DDS

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	122300000X	Dentist	DN19590	FL

General Provider Information

NPI Number	:	1639465388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELANE ALEXIS JENKINS DDS

Provider Business Mailing Address
First Line	:	PO BOX 1357
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-1357
Country	:	US
Telephone Number	:	239-278-3600
Fax Number	:	239-278-3857

Provider Business Practice Location Address
First Line	:	2256 HEITMAN ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3744
Country	:	US
Telephone Number	:	239-278-3600
Fax Number	:	239-278-3857

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	11/21/2011

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