Provider Demographics
NPI:1942472139
Name:ROBERT J. SHELLITO DPM, INC.
Entity type:Organization
Organization Name:ROBERT J. SHELLITO DPM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:SHELLITO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-534-4438
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-0070
Mailing Address - Country:US
Mailing Address - Phone:330-534-4438
Mailing Address - Fax:
Practice Address - Street 1:1543 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6639
Practice Address - Country:US
Practice Address - Phone:330-392-2700
Practice Address - Fax:330-392-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005955213E00000X
OH36003129213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2154163Medicaid
PA101757359 0002Medicaid
OHU78081Medicare UPIN
OH2154163Medicaid
OHRO9375401Medicare PIN
OHSH0895948Medicare PIN
OH6150950001Medicare NSC