Healthcare Provider Details

I. General information

NPI: 1164528535
Provider Name (Legal Business Name): SHELLY LYNN RILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 STONERIDGE RD BLDG F101
AUSTIN TX
78746-7760
US

IV. Provider business mailing address

3660 STONERIDGE RD BLDG F101
AUSTIN TX
78746-7760
US

V. Phone/Fax

Practice location:
  • Phone: 512-329-8222
  • Fax: 512-329-0087
Mailing address:
  • Phone: 512-329-8222
  • Fax: 512-329-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberL8171
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberL8171
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: