Provider Demographics
NPI:1063387124
Name:SHELLUM, DAVID W
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:SHELLUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 138TH AVE NW LOT 115
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-9590
Mailing Address - Country:US
Mailing Address - Phone:701-570-2833
Mailing Address - Fax:
Practice Address - Street 1:5451 138TH AVE NW LOT 115
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-9590
Practice Address - Country:US
Practice Address - Phone:701-570-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty