Provider Demographics
NPI:1386342509
Name:CRUZ, SHELLI RENEE (CCP)
Entity type:Individual
Prefix:
First Name:SHELLI
Middle Name:RENEE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:CCP
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:RENEE
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3105 RUSTIC WOODS CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-4064
Mailing Address - Country:US
Mailing Address - Phone:972-400-2824
Mailing Address - Fax:
Practice Address - Street 1:3105 RUSTIC WOODS CT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4064
Practice Address - Country:US
Practice Address - Phone:972-400-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFPF00001052242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist