Individual
MS. SHELLI ANN BUCKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
2565 JUDGE FRAN JAMIESON WAY, VIERA, FL 32940-5998
(321) 634-3688
(321) 504-0955
Mailing address
2565 JUDGE FRAN JAMIESON WAY, VIERA, FL 32940-5998
(321) 634-3688
(321) 504-0955
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
811692000
—
FL
Enumeration date
03/20/2007
Last updated
01/08/2013
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