MEDICARE: MRS. MELISSA BETH SHELBY ACNP-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	363LA2100X	Acute Care Nurse Practitioner	AP4131	AZ
2	363LA2100X	Acute Care Nurse Practitioner	R107934	MD
3	363LA2100X	Acute Care Nurse Practitioner	APRN11032092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z148991	OTHER	AZ	PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699703462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA BETH SHELBY ACNP-C

Provider Business Mailing Address
First Line	:	2940 E. BANNER GATEWAY DRIVE
Second Line	:	SUITE #450
City	:	GILBERT
State	:	AZ
Zip	:	85234
Country	:	US
Telephone Number	:	480-256-6444
Fax Number	:	480-256-4734

Provider Business Practice Location Address
First Line	:	661 E ALTAMONTE DR STE 231
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5102
Country	:	US
Telephone Number	:	407-303-5214
Fax Number	:	407-303-5215

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	11/05/2024

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