Provider Demographics
NPI:1841231610
Name:SHELLY L. HALL M.D., P.A.
Entity Type:Organization
Organization Name:SHELLY L. HALL M.D., P.A.
Other - Org Name:ISLAND PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-264-4333
Mailing Address - Street 1:4611 US HIGHWAY 17
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8245
Mailing Address - Country:US
Mailing Address - Phone:904-264-4333
Mailing Address - Fax:904-264-4301
Practice Address - Street 1:4611 US HIGHWAY 17
Practice Address - Street 2:SUITE 2
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-8245
Practice Address - Country:US
Practice Address - Phone:904-264-4333
Practice Address - Fax:904-264-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty