Provider Demographics
NPI:1467727180
Name:SHELLMAN, ZACHARY RONDALE (LMT)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:RONDALE
Last Name:SHELLMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 N ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1015
Mailing Address - Country:US
Mailing Address - Phone:321-208-5512
Mailing Address - Fax:407-422-3355
Practice Address - Street 1:888 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1015
Practice Address - Country:US
Practice Address - Phone:321-208-5512
Practice Address - Fax:407-422-3355
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 63551174400000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 63551OtherLICENSED MASSAGE THERAPIST