Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN9426101 | FL |
NPI | 1033769724 |
---|---|
Provider Name | Shelby Nicole Mayoral |
First Address | Miami, FL 33165-6948 |
Second Address | Miami, FL 33176-2118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2019 |
Last Update Date | 23/09/2021 |