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General NPI Number Information
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NPI Number | 1043411523
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Entity Type | Individual
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Provider Name | BRANDON CHAD SHELLEY DPM
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Gender | Male
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 2631 FOOTHILL BLVD SUITE C
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4771
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Country | US
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Telephone | 307-362-9545
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Fax | 307-362-9732
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Provider Business Mailing Address
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Address Line | 2631 FOOTHILL BLVD SUITE C
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4771
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Country | US
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Telephone | 307-362-9545
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Fax | 307-362-9732
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2007005956
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 218
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 218
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License Number State | SD
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2007005956
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 145
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License Number State | WY
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