Provider Demographics
NPI:1497939292
Name:PLUMB, SHELLEY D (DPM)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:D
Last Name:PLUMB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2326 S CONGRESS AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7617
Mailing Address - Country:US
Mailing Address - Phone:561-433-5577
Mailing Address - Fax:561-275-2696
Practice Address - Street 1:2326 S CONGRESS AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7617
Practice Address - Country:US
Practice Address - Phone:561-433-5577
Practice Address - Fax:561-275-2696
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2724213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65620ZMedicare PIN