Provider Demographics
NPI:1902211170
Name:LUEDERS, SHELBY L (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:LUEDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 SW 97TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4667
Mailing Address - Country:US
Mailing Address - Phone:563-357-7877
Mailing Address - Fax:
Practice Address - Street 1:3581 SW ARCHER RD STE 40
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2428
Practice Address - Country:US
Practice Address - Phone:352-888-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074722363AM0700X
FLPA9113408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical