Provider Demographics
NPI:1861772527
Name:PARADIS, SHELINA (ARNP)
Entity type:Individual
Prefix:MS
First Name:SHELINA
Middle Name:
Last Name:PARADIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHELINA
Other - Middle Name:
Other - Last Name:IRVING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:7904 S HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3911
Mailing Address - Country:US
Mailing Address - Phone:321-591-0100
Mailing Address - Fax:
Practice Address - Street 1:101 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8301
Practice Address - Country:US
Practice Address - Phone:321-984-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9202808363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004035500Medicaid
FLFM605ZMedicare PIN