Provider Demographics
NPI:1588284111
Name:FLEWELLEN, SHELBY PAIGE (MD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:PAIGE
Last Name:FLEWELLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 W LAKE MEAD PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7417
Mailing Address - Country:US
Mailing Address - Phone:702-620-5981
Mailing Address - Fax:833-749-0360
Practice Address - Street 1:390 W LAKE MEAD PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7417
Practice Address - Country:US
Practice Address - Phone:702-620-5981
Practice Address - Fax:833-749-0360
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV24408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine