Healthcare Provider Details

I. General information

NPI: 1639136229
Provider Name (Legal Business Name): SHELBY A STEPHENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

PO BOX 64363
FAYETTEVILLE NC
28306-0363
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-2284
  • Fax:
Mailing address:
  • Phone: 910-483-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number24950
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: