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General NPI Number Information
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NPI Number | 1215515887
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Entity Type | Individual
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Provider Name | SHELBY COLLYMORE DO
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Gender | Female
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 2626 SOUTH CARRIER PKWY STE. 300
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-5014
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Country | US
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Telephone | 972-642-7337
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Fax | 972-642-7339
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Provider Business Mailing Address
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Address Line | 2626 SOUTH CARRIER PKWY ST. 300
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-5014
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Country | US
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Telephone | 972-642-7337
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Fax | 972-642-7339
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V1058
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License Number State | TX
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