Provider Demographics
NPI:1477024040
Name:CHARLOT, SHELLA (RN, HAIR LOSS SPECI)
Entity Type:Individual
Prefix:
First Name:SHELLA
Middle Name:
Last Name:CHARLOT
Suffix:
Gender:F
Credentials:RN, HAIR LOSS SPECI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-0489
Mailing Address - Country:US
Mailing Address - Phone:407-914-4451
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR # 467
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:407-914-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies