Provider Demographics
NPI:1093010233
Name:MEDLEY, SHELBY (RRT, RCP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 PERTH PL APT 303
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3322
Mailing Address - Country:US
Mailing Address - Phone:919-800-7308
Mailing Address - Fax:
Practice Address - Street 1:445 CARAWAY DR
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-5403
Practice Address - Country:US
Practice Address - Phone:919-800-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT10614227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered