Provider Demographics
NPI:1689690943
Name:BERRY, SHELREL F (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHELREL
Middle Name:F
Last Name:BERRY
Suffix:
Gender:F
Credentials:APRN
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 9100
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9100
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:
Practice Address - Street 1:103 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4501
Practice Address - Country:US
Practice Address - Phone:850-769-0338
Practice Address - Fax:850-640-2195
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012787367A00000X
AL1052673367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
51534465OtherBLUE CROSS BLUE SHIELD
AL51545741Medicaid
AL891013060Medicaid
AL891013060Medicaid
589159Medicare UPIN