Healthcare Provider Details

I. General information

NPI: 1700571015
Provider Name (Legal Business Name): SHELLEY LABBAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE BLDG 80-83
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

10456 BRACKETS FORD CIR
MANASSAS VA
20110-2746
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-5252
  • Fax:
Mailing address:
  • Phone: 571-247-2209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: