Provider Demographics
NPI:1225714819
Name:JAY, SHELLEY LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LYNN
Last Name:JAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MACCHI AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3059
Mailing Address - Country:US
Mailing Address - Phone:719-505-2019
Mailing Address - Fax:
Practice Address - Street 1:6000 W OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4414
Practice Address - Country:US
Practice Address - Phone:407-586-0138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1647513163WA2000X, 163WC0200X, 163WP2201X, 163WX0106X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health