Provider Demographics
NPI:1437129319
Name:FENTON-ZEIRA, SHELLY (MD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:FENTON-ZEIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:ZEIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1801 LEE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2127
Mailing Address - Country:US
Mailing Address - Phone:407-975-0412
Mailing Address - Fax:407-975-0413
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:FLORIDA HOSPITAL PEDIATRIC HOSPITALISTS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-975-0412
Practice Address - Fax:407-975-0413
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211033208000000X
FLME129378208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01971517Medicaid
NY581212Medicare PIN
NY01971517Medicaid