Individual provider Active NPI

Shelby Lynn Skulley, PA

  • Physician Assistant
  • North Miami Beach, FL
National Provider Identifier
1043078751
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9118536 Issued in FL
Practice address
100 NW 170TH St Ste 301
North Miami Beach, FL 33169-5511
Phone
(305) 651-3038
Fax
(305) 655-1153
NPI assigned
Mar 7, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9118536 FL Primary

Addresses

Primary practice location

100 NW 170TH St Ste 301
North Miami Beach, FL 33169-5511

Mailing address

100 NW 170TH St Ste 301
North Miami Beach, FL 33169-5511
Phone (305) 651-3038

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251011000351 FL Practitioner - Physician Assistant 8527555820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

100 NW 170 St
Suite 301
North Miami Beach, FL 33169-5511

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Vincenzo Novara MD PA CurrentSince Jul 18, 2025 Accepting new patients

Locations

1859 Van Buren St
Hollywood, FL 33020
Phone (954) 920-0900

1100 NW 95th St
Miami Shores, FL 33150
Phone (305) 835-6000

100 NW 170th St
Ste 301
North Miami Beach, FL 33169
Phone (305) 651-3033

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1043078751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NW 170TH ST STE 301",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331695511",
            "telephone_number": "305-651-3038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NW 170TH ST STE 301",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331695511",
            "telephone_number": "305-651-3038",
            "fax_number": "305-655-1153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKULLEY",
        "first_name": "SHELBY",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9118536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Miami Beach, FL

Sources for this page

Verify at the official NPI Registry.