Provider Demographics
NPI:1467698621
Name:GILBERT, SHELLEY M (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:M
Last Name:GILBERT
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:SHELLEY
Other - Middle Name:M
Other - Last Name:BURTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-1209
Mailing Address - Country:US
Mailing Address - Phone:843-652-8220
Mailing Address - Fax:843-520-8365
Practice Address - Street 1:4301 DICK POND RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6807
Practice Address - Country:US
Practice Address - Phone:843-652-8100
Practice Address - Fax:843-652-8122
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TL2725363AM0700X
NY013354363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL2725OtherSC MEDICAL LICENSE
NY03160950Medicaid
NY03160950Medicaid
NYA400014773Medicare PIN