MEDICARE: DR. STEVEN D SHELL DO

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	207Q00000X	Family Medicine Physician	OS8268	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00619611	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	13719	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1851472179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN D SHELL DO

Provider Business Mailing Address
First Line	:	21300 GERTRUDE AVE
Second Line	:	SUITE 1
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5018
Country	:	US
Telephone Number	:	941-743-3311
Fax Number	:	941-743-3313

Provider Business Practice Location Address
First Line	:	21300 GERTRUDE AVE
Second Line	:	SUITE 1
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5018
Country	:	US
Telephone Number	:	941-743-3311
Fax Number	:	941-743-3313

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/21/2012

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Directions to “ DR. STEVEN D SHELL DO” Practice Location

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