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General NPI Number Information
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NPI Number | 1568818029
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Entity Type | Organization
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Legal Business Name | SHELBY PEDIATRICS, LLC
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 1431 N MAIN AVE
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City | SIDNEY
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State | OH
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Zip | 45365-1735
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Country | US
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Telephone | 937-419-8687
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Fax | 937-419-8688
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Provider Business Mailing Address
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Address Line | 1431 N MAIN AVE
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City | SIDNEY
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State | OH
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Zip | 45365-1735
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Country | US
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Telephone | 937-419-8687
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Fax | 937-419-8688
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KAREN S SMITH
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Credential | M.D.
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Telephone | 937-726-3980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35075528
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License Number State | OH
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