Healthcare Provider Details

I. General information

NPI: 1285642264
Provider Name (Legal Business Name): SHELLEY N GOODWEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 N MAIN ST
SALINAS CA
93906-5103
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-443-8200
  • Fax: 831-449-3493
Mailing address:
  • Phone: 831-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG71790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: