Provider Demographics
NPI:1700933512
Name:SHELBY, AIKIESHA (MD)
Entity Type:Individual
Prefix:
First Name:AIKIESHA
Middle Name:
Last Name:SHELBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PRIMERA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2158
Mailing Address - Country:US
Mailing Address - Phone:708-774-9821
Mailing Address - Fax:321-972-9319
Practice Address - Street 1:255 PRIMERA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2158
Practice Address - Country:US
Practice Address - Phone:708-774-9821
Practice Address - Fax:321-972-9319
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1154802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry