Healthcare Provider Details

I. General information

NPI: 1184666307
Provider Name (Legal Business Name): SHELLI G BREGMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
SAINT GEORGE UT
84790-2123
US

IV. Provider business mailing address

4567 CROSSROADS PARK DRIVE
LIVERPOOL NY
13088-3589
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-1000
  • Fax:
Mailing address:
  • Phone: 315-295-2100
  • Fax: 315-295-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberPENDING
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberPENDING
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number244704
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: