Healthcare Provider Details

I. General information

NPI: 1033362272
Provider Name (Legal Business Name): SHIRLEY SHETH D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 SAINT MARY RD
VALPARAISO IN
46383-3986
US

IV. Provider business mailing address

3800 SAINT MARY RD
VALPARAISO IN
46383-3986
US

V. Phone/Fax

Practice location:
  • Phone: 817-657-8677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02003526A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036119237
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: