Provider Demographics
NPI:1023097623
Name:SHACKELFORD, ELANA L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:ELANA
Middle Name:L
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:ELANA
Other - Middle Name:M
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1111 S. ORANGE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-992-0660
Mailing Address - Fax:407-992-7702
Practice Address - Street 1:1111 S. ORANGE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-992-0660
Practice Address - Fax:407-992-7702
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203677207R00000X
FLME89879207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I151211Medicare UPIN
AH715Medicare PIN