Provider Demographics
NPI:1124103619
Name:SHELUB, AARON MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:MICHAEL
Last Name:SHELUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572770
Mailing Address - Street 2:STE 415
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-2770
Mailing Address - Country:US
Mailing Address - Phone:818-506-3384
Mailing Address - Fax:818-699-1278
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:STE 414
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-506-3384
Practice Address - Fax:818-699-1278
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124103619Medicaid
CABC046YMedicare PIN
CABC046ZMedicare PIN