Provider Demographics
NPI:1962437392
Name:SHELBY, JEFFREY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:SHELBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 STATE RT 3
Mailing Address - Street 2:PLATTSBURGH MEDICAL CARE
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-566-0672
Mailing Address - Fax:518-566-0641
Practice Address - Street 1:675 STATE RT 3
Practice Address - Street 2:PLATTSBURGH MEDICAL CARE
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-566-0672
Practice Address - Fax:518-566-0641
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG054026174400000X
NY257161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400062220Medicare PIN