Provider Demographics
NPI:1699703462
Name:SHELBY, MELISSA BETH (ACNP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BETH
Last Name:SHELBY
Suffix:
Gender:F
Credentials:ACNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 E. BANNER GATEWAY DRIVE
Mailing Address - Street 2:SUITE #450
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-256-6444
Mailing Address - Fax:480-256-4734
Practice Address - Street 1:661 E ALTAMONTE DR STE 231
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5102
Practice Address - Country:US
Practice Address - Phone:407-303-5214
Practice Address - Fax:407-303-5215
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4131363LA2100X
MDR107934363LA2100X
FLAPRN11032092363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ148991OtherPTAN
MD768511400Medicaid
MDKR71JHMedicare ID - Type Unspecified
MD768511400Medicaid