Healthcare Provider Details

I. General information

NPI: 1356547640
Provider Name (Legal Business Name): JEFFRY JOHN SHELLENBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 MCPHERSON RD
LAREDO TX
78041-6561
US

IV. Provider business mailing address

6 LAKEVIEW PL
HOUSTON TX
77070-1300
US

V. Phone/Fax

Practice location:
  • Phone: 956-242-6790
  • Fax:
Mailing address:
  • Phone: 281-827-4262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP3583
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberP3583
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: