Basic Information
Provider Information
NPI: 1639448293
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUGHES
FirstName: SHELBY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5827 CORPORATE WAY
Address2:  
City: WEST PALM BEACH
State: FL
PostalCode: 334072000
CountryCode: US
TelephoneNumber: 5618449443
FaxNumber: 5614729692
Practice Location
Address1: 3441 SE WILLOUGHBY BLVD
Address2:  
City: STUART
State: FL
PostalCode: 349945060
CountryCode: US
TelephoneNumber: 7722191222
FaxNumber: 5614729690
Other Information
ProviderEnumerationDate: 12/27/2011
LastUpdateDate: 03/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

ID Information
IDTypeStateIssuerDescription
RN23688001GAAMCBOTHER
ARNP940555301FLARNPOTHER


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