Individual
DR. SHELLEY SUE JAQUISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6827 FIRST AVENUE SOUTH, SUITE 100, ST PETERSBURG, FL 33707-4516
(727) 341-0551
(727) 341-0332
Mailing address
10002 PRINCESS PALM AVE STE 332, TAMPA, FL 33619-8327
(813) 571-7184
(813) 654-4695
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME82762
FL
207YX0602X
Otolaryngic Allergy Physician
ME82762
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01150
BCBS
FL
01
—
1000331
UNITED HEALTH CARE
FL
01
—
220342
AMERIGROUP
FL
01
—
2597386
AETNA
FL
05
—
261879600
—
FL
01
—
280250
AVMED
FL
01
—
3839012002
CIGNA
FL
Enumeration date
05/02/2006
Last updated
04/24/2019
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