Provider Demographics
NPI:1396943056
Name:BISH, SHELLY MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:MARIE
Last Name:BISH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6799 OVERSEAS HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2787
Mailing Address - Country:US
Mailing Address - Phone:305-851-8903
Mailing Address - Fax:305-720-2621
Practice Address - Street 1:6799 OVERSEAS HWY STE 1
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2787
Practice Address - Country:US
Practice Address - Phone:305-851-8903
Practice Address - Fax:305-720-2621
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9414891363LF0000X
FLARNP9414891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01579648Medicaid
NYJ400043534Medicare PIN