Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME89879 | FL |
N | 207R00000X | Internist | ARNP9203677 | FL |
N | 111NI0900X | Internist | ARNP9203677 | FL |
NPI | 1023097623 |
---|---|
Provider Name | Mrs. Elana L Shackelford |
First Address | Orlando, FL 32806 |
Second Address | Orlando, FL 32806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 12/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I151211 | (02) |