Provider Demographics
NPI:1962611947
Name:NIELSEN, WELBY (DO)
Entity type:Individual
Prefix:
First Name:WELBY
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:1039 MURRAY AVE STE 220
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-2058
Practice Address - Country:US
Practice Address - Phone:805-250-2996
Practice Address - Fax:805-250-2998
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A111772084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry