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General NPI Number Information
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NPI Number | 1902197734
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Entity Type | Individual
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Provider Name | SHELBY RESNICK M.D
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Gender | Female
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 1510 SAN PABLO ST HCC-I 514
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City | LOS ANGELES
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State | CA
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Zip | 90033-5320
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Country | US
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Telephone | 323-442-5876
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Fax |
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Provider Business Mailing Address
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Address Line | 51 N 39TH ST MOB, SUITE 120
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 215-349-8310
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A116185
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MD454040
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License Number State | PA
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