Active NPI
Shirley Ellacer
- Contractor
- Leesburg, FL
National Provider Identifier
1982738241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- PT23179
- Practice address
- 33229 Ryan Dr
Apt 15
Leesburg, FL 34788-3718 - Phone
- (317) 987-2603
- NPI assigned
- Mar 16, 2007
- Last updated
- Feb 4, 2009
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | PT23179 | FL | Primary |
Addresses
Primary practice location
33229 Ryan Dr
Apt 15
Leesburg, FL 34788-3718
Mailing address
33229 Ryan Dr
Apt 15
Leesburg, FL 34788-3718
Phone (317) 987-2603
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT23179 | FL | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233705600000",
"number": "1982738241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33229 RYAN DR",
"address_2": "APT 15",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347883718",
"telephone_number": "317-987-2603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33229 RYAN DR",
"address_2": "APT 15",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347883718",
"telephone_number": "317-987-2603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLACER",
"first_name": "SHIRLEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-16",
"last_updated": "2009-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "FL",
"license": "PT23179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.