Provider Demographics
NPI:1093343162
Name:BECKHOLT, SHELBY ROSE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ROSE
Last Name:BECKHOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:897 DELAWARE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2087
Mailing Address - Country:US
Mailing Address - Phone:716-846-1190
Mailing Address - Fax:
Practice Address - Street 1:192 PARK CLUB LN STE 120
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5270
Practice Address - Country:US
Practice Address - Phone:716-559-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328820207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology