Provider Demographics
NPI:1417242231
Name:SOUCY, SHELLEY ANN
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:SOUCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13006 MONTROSE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4090
Mailing Address - Country:US
Mailing Address - Phone:727-831-8477
Mailing Address - Fax:813-374-9611
Practice Address - Street 1:13006 MONTROSE GROVE CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-4090
Practice Address - Country:US
Practice Address - Phone:727-831-8477
Practice Address - Fax:813-374-9611
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health