Provider Demographics
NPI:1588919963
Name:DELLA MONICA, SHANNON KELSEY (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KELSEY
Last Name:DELLA MONICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6451 BRENTWOOD STAIR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3200
Mailing Address - Country:US
Mailing Address - Phone:214-802-8203
Mailing Address - Fax:
Practice Address - Street 1:6451 BRENTWOOD STAIR RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3200
Practice Address - Country:US
Practice Address - Phone:214-802-8203
Practice Address - Fax:817-507-1768
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101084207P00000X
TXQ9364207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine