Provider Demographics
NPI:1205835311
Name:SHELLY MEDICAL SUPPLY, CORP.
Entity Type:Organization
Organization Name:SHELLY MEDICAL SUPPLY, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARACELI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-274-8174
Mailing Address - Street 1:9745 SW 72ND ST
Mailing Address - Street 2:STE 125/7
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4652
Mailing Address - Country:US
Mailing Address - Phone:305-274-8174
Mailing Address - Fax:305-274-8173
Practice Address - Street 1:9745 SW 72ND ST
Practice Address - Street 2:STE 125/7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4652
Practice Address - Country:US
Practice Address - Phone:305-274-8174
Practice Address - Fax:305-274-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5399190001Medicare ID - Type Unspecified