Provider Demographics
NPI:1417410861
Name:KEYSER, SHELBY MARIE (DO)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:MARIE
Last Name:KEYSER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:MARIE
Other - Last Name:STEGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 E LANCASTER AVE STE 158
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3427
Mailing Address - Country:US
Mailing Address - Phone:610-649-2126
Mailing Address - Fax:
Practice Address - Street 1:100 E LANCASTER AVE STE 158
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3427
Practice Address - Country:US
Practice Address - Phone:610-649-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS024744207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology