Provider Demographics
NPI:1104402189
Name:BRIDGETT, SHELBY LEE (DO)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LEE
Last Name:BRIDGETT
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 1:136 E 36TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2018
Mailing Address - Country:US
Mailing Address - Phone:704-801-3401
Mailing Address - Fax:704-801-3401
Practice Address - Street 1:136 E 36TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2018
Practice Address - Country:US
Practice Address - Phone:704-801-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine