MEDICARE: MS. SHELLY N. SINGH LCSW

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	1041C0700X	Clinical Social Worker	SW9204	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BR336A	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1760534614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLY N. SINGH LCSW

Provider Business Mailing Address
First Line	:	1870 N LAWNWOOD CIR
Second Line	:	SUITE A - E
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4828
Country	:	US
Telephone Number	:	772-461-0820
Fax Number	:	772-461-0823

Provider Business Practice Location Address
First Line	:	1870 N LAWNWOOD CIR
Second Line	:	SUITE A - E
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4828
Country	:	US
Telephone Number	:	772-461-0820
Fax Number	:	772-467-0823

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	04/17/2013

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