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General NPI Number Information
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NPI Number | 1356080337
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Entity Type | Individual
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Provider Name | SHELBY MCNEILLY DO
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5189
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Country | US
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Telephone | 753-680-0836
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Fax |
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Provider Business Mailing Address
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Address Line | 317 N BROAD ST APT 611
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1017
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Country | US
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Telephone | 315-409-5191
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OT021618
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License Number State | PA
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