Provider Demographics
NPI:1356435259
Name:ROGER H.SHELLING,M.D.,P.A.
Entity type:Organization
Organization Name:ROGER H.SHELLING,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:SHELLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-772-8207
Mailing Address - Street 1:5601 N.DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FT.LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-772-8207
Mailing Address - Fax:954-938-8056
Practice Address - Street 1:5601 N.DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:FT.LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-772-8207
Practice Address - Fax:954-938-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035947208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66117100Medicaid
FL93924Medicare ID - Type Unspecified
FL66117100Medicaid