MR. SHAWN DEMIAN KELLY APRN NPI 1174831093

NPI Information

NPI: 1174831093
Provider Name: MR. SHAWN DEMIAN KELLY, APRN
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1667 N CLYDE MORRIS BLVD STE 2
DAYTONA BEACH, FL
ZIP 32117
Phone: (386) 274-1414
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MR. Shawn Demian Kelly, APRN is a family nurse practitioner in Daytona Beach, FL with 14 years of experience. MR. Shawn Demian Kelly, APRN NPI is 1174831093. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIFORMED SERVICES UHS FE HEBERT SCHOOL OF MED
Graduation Year:2010

The provider's business location address is:

1667 N CLYDE MORRIS BLVD STE 2
DAYTONA BEACH, FL
ZIP 32117-500
Phone: (386) 274-1414

The NPI 1174831093 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/14/2010 and was last updated on 1/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	APRN9431397	FLORIDA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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