Active NPI
Shelly Fonseca
- Physical Therapist
- Lutz, FL
National Provider Identifier
1174060305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10331
- Practice address
- 19008 Avenue Bayonnes
Lutz, FL 33558-5356 - Phone
- (305) 469-5014
- NPI assigned
- Jan 26, 2017
- Last updated
- Jan 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10331 | FL | Primary |
Addresses
Primary practice location
19008 Avenue Bayonnes
Lutz, FL 33558-5356
Mailing address
19008 Avenue Bayonnes
Lutz, FL 33558-5356
Phone (305) 469-5014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10331 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485388800000",
"number": "1174060305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19008 AVENUE BAYONNES",
"city": "LUTZ",
"state": "FL",
"postal_code": "335585356",
"telephone_number": "305-469-5014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19008 AVENUE BAYONNES",
"city": "LUTZ",
"state": "FL",
"postal_code": "335585356",
"telephone_number": "305-469-5014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONSECA",
"first_name": "SHELLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-26",
"last_updated": "2017-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "10331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lutz, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.