Provider Demographics
NPI:1285051409
Name:FLORIDA SPECIALTY MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:FLORIDA SPECIALTY MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:772-708-6776
Mailing Address - Street 1:16057 TAMPA PALMS BLVD W
Mailing Address - Street 2:223
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2001
Mailing Address - Country:US
Mailing Address - Phone:813-493-3376
Mailing Address - Fax:
Practice Address - Street 1:16057 TAMPA PALMS BLVD W
Practice Address - Street 2:223
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2001
Practice Address - Country:US
Practice Address - Phone:813-493-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SPECIALTY MEDICAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100378207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty