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SHALYN MACKENZIE FULLERTON MD
NPI 1053161224
Surgery in Jacksonville, FL

Active since March 22, 2024PECOS Enrolled
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224(904) 953-2000 Get Directions Write a Review

NPPES record last updated: November 24, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 24, 2025, Jun 13, 2025, Jul 25, 2024 (3 updates tracked since 2024).

About Shalyn Mackenzie Fullerton Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHALYN MACKENZIE FULLERTON MD (NPI 1053161224) is an individual surgery provider in Jacksonville, Florida, licensed in Florida (ME176717) and active in the NPI registry since March 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053161224
Entity TypeIndividualFemale
Primary Taxonomy208600000X
Provider Legal NameSHALYN MACKENZIE FULLERTONCredential: MD
Location Address4500 SAN PABLO RD SJacksonville, FL 32224-1865
Mailing AddressPo Box 860912Minneapolis, MN 55486-0912 · (904) 953-2000
Phone(904) 953-2000
Sole ProprietorNo
Enumeration DateMarch 22, 2024
Last NPPES UpdateNovember 24, 20253 updates tracked since enumeration
NPPES CertifiedNovember 24, 2025
✔ NPI 1053161224 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgeryAllopathic & Osteopathic Physicians
Taxonomy Code208600000X
License✔ Licensed in FL · ME176717
Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

4500 SAN PABLO RD S, Jacksonville, FL 32224
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shalyn Mackenzie Fullerton Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32224 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.62 typical visit price
range $56.00 – $171.84
Typical copayment $21.90 (range $14.00 – $42.96)
Most-billed visit code 99203
Established Patient
$70.04 typical visit price
range $17.57 – $139.16
Typical copayment $17.51 (range $4.39 – $34.79)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHERINE L WALSH PA-C/MPH
Physician Assistant
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
DR. JAMI ANN ROTHE KINNUCAN M.D.
Internal Medicine (Gastroenterology)
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
GLENN SHI MD
Orthopaedic Surgery
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
MICHELLE TULANG MD
Internal Medicine
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
RICARDO PAGAN MD
Hospitalist
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
CRYSTAL LYNN CRNA
Nurse Anesthetist, Certified Registered
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
LAUREN E FREED CRNA
Nurse Anesthetist, Certified Registered
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2000
MRS. MELINA VOLNER SOMMESE PA-C
Physician Assistant
4500 SAN PABLO RD S
JACKSONVILLE, FL 32224
Duval County (904) 953-2594

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shalyn Fullerton's NPI number?

The NPI number for Shalyn Fullerton is 1053161224. It was assigned to this individual provider in the NPPES registry on March 22, 2024.

Where is Shalyn Fullerton located?

Shalyn Fullerton practices at 4500 San Pablo Rd S, Jacksonville, FL 32224. The listed phone number is (904) 953-2000.

What is Shalyn Fullerton's specialty?

The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.

Is Shalyn Fullerton enrolled in Medicare?

Yes. Shalyn Fullerton is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Shalyn Fullerton was last updated on November 24, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.