Shawn Demian Kelly, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN9431397 Issued in FL

Practice address

1667 N Clyde Morris Blvd Ste 2
Daytona Beach, FL 32117-5500

Phone

(386) 274-1414

NPI assigned

Sep 14, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Uniformed Services Uhs Fe Hebert School of Med, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeside Endocrine Associates IncGroup PAC ID 9133408008, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Daytona Beach Hospital, Daytona Beach, FL, CCN 100068
• AdventHealth Palm Coast Hospital, Palm Coast, FL, CCN 100118
• Adventhealth New Smyrna Beach Hospital, New Smyrna Beach, FL, CCN 100014
• Halifax Health Medical Center Hospital, Daytona Beach, FL, CCN 100017
• Adventhealth Palm Coast Parkway Hospital, Palm Coast, FL, CCN 100363

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12862/brand/1/csg/1/fhir/r4
• Direct secure messaging: shawn.kelly.1@12862.direct.athenahealth.com

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.

• Lakeside Endocrine Associates, Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Daytona Beach, FL
  • NPI 1871041681
  Medicare reassignment Care Compare group NPD
• Vera Endocrine Associates Inc

  • Specialist
  • Daytona Beach, FL
  • NPI 1841375193
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Adventhealth Palm Coast Parkway Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1861102345
  Care Compare affiliation
• Halifax Hospital Medical Center

  • General Acute Care Hospital
  • Daytona Beach, FL
  • NPI 1811991227
  Care Compare affiliation
• Memorial Health Systems Inc

  • General Acute Care Hospital
  • Daytona Beach, FL
  • NPI 1063426823
  Care Compare affiliation
• Memorial Health Systems Inc

  • Clinical Medical Laboratory
  • Daytona Beach, FL
  • NPI 1104696178

  Hospital

  Care Compare affiliation
• Memorial Hospital Flagler Inc

  • General Acute Care Hospital
  • Palm Coast, FL
  • NPI 1679678486
  Care Compare affiliation
• Southeast Volusia Healthcare Corporation

  • General Acute Care Hospital
  • New Smyrna Beach, FL
  • NPI 1871977942
  Care Compare affiliation

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

{
    "created_epoch": "1284422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1174831093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1667 N CLYDE MORRIS BLVD STE 2",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175500",
            "telephone_number": "386-274-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1667 N CLYDE MORRIS BLVD STE 2",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321175500",
            "telephone_number": "386-274-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHAWN",
        "middle_name": "DEMIAN",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-14",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9431397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corrina Kelch, ARNP
• Kelly Cares Inc
• Coreen Kelly
• Daniel William Kelly, PA-C
• Elizabeth Victoria Kelly, PA STUDENT
• Robert Kemp, LMHC
• Kemshol Medical Center PA
• Ruth Kent, PT
• Julia Kerbs
• Sepeedeh Zahra Kermalli, DO

• Family Nurse Practitioner in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.