Provider Demographics
NPI:1326033085
Name:SHABER, MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SHABER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3661 S BABCOCK ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8205
Practice Address - Country:US
Practice Address - Phone:321-868-4120
Practice Address - Fax:321-868-4135
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN131609363LA2200X
MO131609363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHG280YOtherMEDICARE
FL008990900Medicaid
MOS52904Medicare UPIN