MEDICARE: SHELBY WOOD

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	363A00000X	Physician Assistant	10002181A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01824841	OTHER		RR PTAN

General Provider Information

NPI Number	:	1912443623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY WOOD

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7250 CLEARVISTA DR
Second Line	:	STE 355
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-4692
Country	:	US
Telephone Number	:	317-621-5676
Fax Number	:

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

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	12/22/2025

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Directions to “ SHELBY WOOD ” Practice Location

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