Provider Demographics
NPI:1801924717
Name:PARKER, SHELLIE ROBYN-KATHERINE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:SHELLIE
Middle Name:ROBYN-KATHERINE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 NW 91ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-3535
Mailing Address - Country:US
Mailing Address - Phone:305-527-7164
Mailing Address - Fax:
Practice Address - Street 1:2345 NW 91ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-3535
Practice Address - Country:US
Practice Address - Phone:305-527-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant