Provider Demographics
NPI:1558896126
Name:HOLLAND, SHELBY ANDERSON (DO)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:ANDERSON
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:NICOLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 METROPOLITAN PARK DR.
Mailing Address - Street 2:STE. 100
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-870-9369
Mailing Address - Fax:315-870-9364
Practice Address - Street 1:1226 EAST WATER STREET
Practice Address - Street 2:SUITE D
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-234-4565
Practice Address - Fax:315-451-2158
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO879502085R0202X, 2085R0204X
NY3288972085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology