Provider Demographics
NPI:1124884747
Name:SHELLY, ANNA MARIA (DPT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:SHELLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 ELVAS AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-1913
Mailing Address - Country:US
Mailing Address - Phone:916-457-8802
Mailing Address - Fax:916-457-7609
Practice Address - Street 1:3400 ELVAS AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-1913
Practice Address - Country:US
Practice Address - Phone:916-457-8802
Practice Address - Fax:916-457-7609
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305652208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation