Provider Demographics
NPI:1912642794
Name:ELLIOTT, SHELBY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:ANN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELBY
Other - Middle Name:ANN
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:NAVAL SPECIAL WARFARE COMMAND 2000 TRIDENT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-0001
Mailing Address - Country:US
Mailing Address - Phone:410-382-9598
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program