Provider Demographics
NPI:1700417334
Name:ROSADO MERCADO, SHELLY MICHELLE
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MICHELLE
Last Name:ROSADO MERCADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 CALLE W BOSCH APT 405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4666
Mailing Address - Country:US
Mailing Address - Phone:787-413-9886
Mailing Address - Fax:
Practice Address - Street 1:1299 CALLE W BOSCH APT 405
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4666
Practice Address - Country:US
Practice Address - Phone:787-413-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program