MEDICARE: DARRELL ANTHONY SHELL MBA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1871912329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL ANTHONY SHELL MBA

Provider Business Mailing Address
First Line	:	435 S RIDGEWOOD AVE # 118
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4927
Country	:	US
Telephone Number	:	386-319-4734
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 S RIDGEWOOD AVE # 118
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4927
Country	:	US
Telephone Number	:	386-319-4734
Fax Number	:	386-200-6293

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	10/17/2019

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