Provider Demographics
NPI:1235262866
Name:ADAM, SHELLI M (PAC)
Entity Type:Individual
Prefix:MS
First Name:SHELLI
Middle Name:M
Last Name:ADAM
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 UNIVERSITY PKWY STE 202308
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2893
Mailing Address - Country:US
Mailing Address - Phone:941-360-2579
Mailing Address - Fax:941-360-2580
Practice Address - Street 1:2401 UNIVERSITY PKWY STE 202
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2973
Practice Address - Country:US
Practice Address - Phone:941-360-2579
Practice Address - Fax:941-360-2580
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103984363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA 9103984OtherLICENSE NUMBER