Provider Demographics
NPI:1982738241
Name:ELLACER, SHIRLEY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:ELLACER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33229 RYAN DR
Mailing Address - Street 2:APT 15
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3718
Mailing Address - Country:US
Mailing Address - Phone:317-987-2603
Mailing Address - Fax:
Practice Address - Street 1:33229 RYAN DR
Practice Address - Street 2:APT 15
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3718
Practice Address - Country:US
Practice Address - Phone:317-987-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23179171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor