Provider Demographics
NPI:1245652817
Name:KELLY-SHELBY, ANGELA MASTRACCHIO (ARNP/FNP-C)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MASTRACCHIO
Last Name:KELLY-SHELBY
Suffix:
Gender:F
Credentials:ARNP/FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 QUINBY WAY
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-8698
Mailing Address - Country:US
Mailing Address - Phone:352-391-4818
Mailing Address - Fax:
Practice Address - Street 1:627 QUINBY WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-8698
Practice Address - Country:US
Practice Address - Phone:352-391-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL ARNP # 2202962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590634434-008OtherHUMANA-MILITARY
FL500022154OtherRR MEDICARE GROUP
FL3023141-00Medicaid
FL7555531OtherPRO-AMERICA-BCE EMERGIS
FLY6666XMedicare PIN