Healthcare Provider Details

I. General information

NPI: 1386137776
Provider Name (Legal Business Name): SHELBY LYNN DEAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LYSTER ARMY HEALTH CLINIC 301 ANDREWS AVENUE
FORT RUCKER AL
36362
US

IV. Provider business mailing address

25 DONOVAN LN
FORT RUCKER AL
36362-2411
US

V. Phone/Fax

Practice location:
  • Phone: 800-261-7193
  • Fax:
Mailing address:
  • Phone: 801-830-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberDOS2019
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: