Provider Demographics
NPI:1952424251
Name:MAY, SHELLIE CHRISTINA (MED)
Entity Type:Individual
Prefix:MRS
First Name:SHELLIE
Middle Name:CHRISTINA
Last Name:MAY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 OHIO AVE S UNIT 177
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-7707
Mailing Address - Country:US
Mailing Address - Phone:386-362-3231
Mailing Address - Fax:888-841-9040
Practice Address - Street 1:400 OHIO AVE S UNIT 177
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-7707
Practice Address - Country:US
Practice Address - Phone:386-362-3231
Practice Address - Fax:888-841-9040
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 5079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889323300Medicaid
FLS2724OtherBLUE CROSS BLUE SHEILD PR