Provider Demographics
NPI:1285178194
Name:GRAHAM, SHELLEY RAE I (RT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RAE
Last Name:GRAHAM
Suffix:I
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8844
Mailing Address - Country:US
Mailing Address - Phone:727-893-6027
Mailing Address - Fax:727-893-6956
Practice Address - Street 1:2201 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8844
Practice Address - Country:US
Practice Address - Phone:727-893-6027
Practice Address - Fax:727-893-6956
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL98302471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging