Healthcare Provider Details

I. General information

NPI: 1093977209
Provider Name (Legal Business Name): SHAIJA SHELBY KUTTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAIJA SHELBY MD

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE STREET CMSC 2-116
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-0106
  • Fax: 410-955-1464
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5759
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberD86316
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: