Healthcare Provider Details

I. General information

NPI: 1154702827
Provider Name (Legal Business Name): SHELLEY BRAND D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MATTHEW DR
WAYNESBORO MS
39367
US

IV. Provider business mailing address

PO BOX 1249
WAYNESBORO MS
39367
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-7243
  • Fax: 601-735-7244
Mailing address:
  • Phone: 601-735-5151
  • Fax: 601-735-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number838
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberT55-2015
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD001377
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: