Provider Demographics
NPI:1992763338
Name:SHELL, JUDITH ANN (RN,PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:SHELL
Suffix:
Gender:F
Credentials:RN,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4937
Mailing Address - Country:US
Mailing Address - Phone:407-933-2775
Mailing Address - Fax:407-933-8406
Practice Address - Street 1:737 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4937
Practice Address - Country:US
Practice Address - Phone:407-933-2775
Practice Address - Fax:407-933-8406
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1906106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist