Shelli Ann Buckley, MED

Key facts

NPI

1255456117

Entity type

Individual (NPI type 1)

Primary specialty

Developmental Therapist 222Q00000X

Practice address

2565 Judge Fran Jamieson Way
Viera, FL 32940-5998

Phone

(321) 634-3688

Fax

(321) 504-0955

NPI assigned

Mar 20, 2007

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Education

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 8, 2013.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357603200000",
    "number": "1255456117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2565 JUDGE FRAN JAMIESON WAY",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "329405998",
            "telephone_number": "321-634-3688",
            "fax_number": "321-504-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2565 JUDGE FRAN JAMIESON WAY",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "329405998",
            "telephone_number": "321-634-3688",
            "fax_number": "321-504-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "SHELLI",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2013-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "811692000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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