Provider Demographics
NPI:1114969839
Name:GLOVER, SHELLEY C (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:C
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1725 E HIGHWAY 50
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5188
Mailing Address - Country:US
Mailing Address - Phone:352-243-6686
Mailing Address - Fax:352-243-2414
Practice Address - Street 1:1725 E HIGHWAY 50
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5188
Practice Address - Country:US
Practice Address - Phone:352-243-6686
Practice Address - Fax:352-243-2414
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81410207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261021300Medicaid
G50282Medicare UPIN
FL261021300Medicaid