Provider Demographics
NPI:1053166108
Name:MOORS, SHELBY L (CNA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:MOORS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9016 NE 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-4648
Mailing Address - Country:US
Mailing Address - Phone:317-496-4088
Mailing Address - Fax:
Practice Address - Street 1:9016 NE 108TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-4648
Practice Address - Country:US
Practice Address - Phone:317-496-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA423876376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide