Shelley Smith Tickett

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME90313 Issued in FL

Practice address

901 E Bloomingdale Ave Ste 501
Brandon, FL 33511-8118

Phone

(813) 699-3995

NPI assigned

May 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Shelley Smith Stevens Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Physicians Inc

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1285686675
  Medicare reassignment
• Saltzman, Tanis, Pittell, Levin and Jacobson, LLC

  • Pediatrics Physician
  • Brandon, FL
  • NPI 1639945892
  NPD
• Carrollwood Emergency Physicians PA

  • Emergency Medicine Physician
  • Tampa, FL
  • NPI 1215988829
  NPD (past)
• Florida Em-I Medical Services PA

  • Emergency Medicine Physician
  • Lakeland, FL
  • NPI 1871542720
  NPD (past)
• Franklin, Favata & Hulls, MD'S, PA

  • Emergency Medicine Physician
  • Tampa, FL
  • NPI 1841240439
  NPD (past)
• Saltzman, Tanis, Pittell, Levin and Jacobson

  • Pediatrics Physician
  • Hollywood, FL
  • NPI 1639138480
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1023064292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14902 HERONGLEN DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335475887",
            "telephone_number": "813-317-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 E BLOOMINGDALE AVE STE 501",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118118",
            "telephone_number": "813-699-3995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKETT",
        "first_name": "SHELLEY",
        "middle_name": "SMITH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME90313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269812900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "44141",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLEY",
            "last_name": "STEVENS",
            "middle_name": "SMITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leyla Inez Thornton
• Rowan Thorpe
• Thread of Hope Counseling, LLC
• Thrive 3 21
• Andrea Mercedes Thurman, PTA
• Batina Timmons, MS, RD, LD, LN
• Timothy C. Runyon, D.P.M. P.a.
• Timothy M Bradley MD Pediatric Orthopedic Surgeon PA
• Gerardo Tinajero
• Tinkle and Toot

• Pediatrics Physician in Brandon, FL
• Providers in Brandon, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.