Provider Demographics
NPI:1346221140
Name:SHUTT-PAEZ, MICHELE L (DC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:SHUTT-PAEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ORCHARD GROVE PL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4671
Mailing Address - Country:US
Mailing Address - Phone:813-818-9327
Mailing Address - Fax:
Practice Address - Street 1:1221 E TARPON AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-5441
Practice Address - Country:US
Practice Address - Phone:727-771-8181
Practice Address - Fax:727-940-8997
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381304500Medicaid
FLU89404Medicare UPIN
FL381304500Medicaid