Healthcare Provider Details

I. General information

NPI: 1871530147
Provider Name (Legal Business Name): WENDY B. SHELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY CLOSSHEY

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 FROST ST PLAZA LEVEL
SAN DIEGO CA
92123-2778
US

IV. Provider business mailing address

8010 FROST STREET PLAZA LEVEL
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-505-5500
  • Fax: 858-505-5555
Mailing address:
  • Phone: 858-505-5500
  • Fax: 858-505-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA90649
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberA90649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: