Shelby Denise McCormick

Primary specialty

DentistTaxonomy code 122300000X

License

DN30962 Issued in FL

Practice address

12427 Highway 231
Youngstown, FL 32466-2562

Phone

(850) 753-3246

NPI assigned

Mar 6, 2023

Last updated

Jun 2, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dentist

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Panama City, FL
  • NPI 1366456287

  Single Specialty

  Medicare reassignment NPD
• Pancare of Florida, Inc

  • Federally Qualified Health Center (FQHC)
  • Bristol, FL
  • NPI 1275346108
  NPD (past)

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

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1922708247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 E 11TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013409",
            "telephone_number": "850-747-5599",
            "fax_number": "850-872-4131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12427 HIGHWAY 231",
            "city": "YOUNGSTOWN",
            "state": "FL",
            "postal_code": "324662562",
            "telephone_number": "850-753-3246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "SHELBY",
        "middle_name": "DENISE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-06",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN30962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeri Dawn Fallin-Roberts, CNA, MEDICATION ADMI
• Kimberly Gandy, LMHC
• Etta Holden
• Sandra Anita Kavulla
• Kayleigh Koskan
• Jennifer A McDaniel, LMT
• Pancare of Florida, Inc
• Pancare of Florida, Inc
• Sheena R Pate, DMD
• Sharon Lynn Patterson

• Dentist in Youngstown, FL
• Providers in Youngstown, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.