Provider Demographics
NPI:1548617038
Name:BIRCH, SHELLY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:ANNE
Last Name:BIRCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3244 RIVERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6269
Mailing Address - Country:US
Mailing Address - Phone:847-975-1298
Mailing Address - Fax:386-226-4577
Practice Address - Street 1:303 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2709
Practice Address - Country:US
Practice Address - Phone:386-425-4100
Practice Address - Fax:386-258-4875
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME141349207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine