Provider Demographics
NPI:1821276254
Name:CORDISCO, SHELLY GRETZINGER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:GRETZINGER
Last Name:CORDISCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:420
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-672-1256
Mailing Address - Fax:305-672-1266
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:420
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-672-1256
Practice Address - Fax:305-672-1266
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9185312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily