MEDICARE: DAVID M SHELBURNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2011-00398	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750548145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M SHELBURNE MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:	WFUHS - FAMILY MEDICINE REYNOLDA
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-896-1146

Provider Business Practice Location Address
First Line	:	3020 BONBROOK DRIVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-0000
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-896-1146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	11/17/2011

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