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General NPI Number Information
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NPI Number | 1841419033
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Entity Type | Organization
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Legal Business Name | SHELLEY E. WEISS MD PA
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 7777 FOREST LN SUITE C-550
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City | DALLAS
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State | TX
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Zip | 75230-2505
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Country | US
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Telephone | 972-566-4286
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN SUITE C-550
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City | DALLAS
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State | TX
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Zip | 75230-2505
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Country | US
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Telephone | 972-566-4286
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELLEY E WEISS
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Credential | M.D.
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Telephone | 972-566-4780
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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 | L0958
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License Number State | TX
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