Individual
SHELBY A LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3319 NE 15TH CT, FORT LAUDERDALE, FL 33304-1709
(954) 257-7859
(954) 616-8063
Mailing address
3319 NE 15TH CT, FORT LAUDERDALE, FL 33304-1709
(954) 257-7859
(954) 616-8063
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA 9106913
FL
363AS0400X
Surgical Physician Assistant
Primary
PA 9106913
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9675Z
MEDICARE ID-TYPE UNSPECIFIED
FL
Enumeration date
10/16/2012
Last updated
05/07/2019
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