Provider Demographics
NPI:1083175541
Name:REVESZ, SHELLEY (DO)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:
Last Name:REVESZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 RITCHIE HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2741
Mailing Address - Country:US
Mailing Address - Phone:410-789-7337
Mailing Address - Fax:859-323-1315
Practice Address - Street 1:1460 RITCHIE HWY STE 209
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2741
Practice Address - Country:US
Practice Address - Phone:410-789-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05223208M00000X
390200000X
MDH0097709208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program