Provider Demographics
NPI:1467911297
Name:PAYNE, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7490 ELEANOR CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4547
Mailing Address - Country:US
Mailing Address - Phone:813-453-0816
Mailing Address - Fax:
Practice Address - Street 1:1721 E 19TH AVE STE 520
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1243
Practice Address - Country:US
Practice Address - Phone:303-869-2278
Practice Address - Fax:866-501-9803
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13877608-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology