Provider Demographics
NPI:1124099122
Name:SHELLEY, DONALD W (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:SHELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4266
Mailing Address - Country:US
Mailing Address - Phone:864-271-3354
Mailing Address - Fax:864-250-6443
Practice Address - Street 1:601 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3403
Practice Address - Country:US
Practice Address - Phone:864-458-7956
Practice Address - Fax:864-458-8390
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7319207W00000X
NC17435207W00000X
GA014859207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4232678OtherAETNA PROVIDER NUMBER
SC73191Medicaid
SCB91336Medicare UPIN