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General NPI Number Information
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NPI Number | 1093343162
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Entity Type | Individual
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Provider Name | SHELBY ROSE BECKHOLT
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 192 PARK CLUB LN STE 120
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5270
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Country | US
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Telephone | 716-559-3803
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Fax |
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Provider Business Mailing Address
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Address Line | 897 DELAWARE AVE STE 301
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City | BUFFALO
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State | NY
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Zip | 14209-2087
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Country | US
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Telephone | 716-846-1190
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 328820
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License Number State | NY
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