MEDICARE: BRIAN MAURICE SHEFULSKY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	2019041268	MO

General Provider Information

NPI Number	:	1992189997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN MAURICE SHEFULSKY DO

Provider Business Mailing Address
First Line	:	1401 S PARK ST
Second Line	:
City	:	EL DORADO SPRINGS
State	:	MO
Zip	:	64744-2037
Country	:	US
Telephone Number	:	417-876-2511
Fax Number	:	417-876-3812

Provider Business Practice Location Address
First Line	:	807 OWENS MILL RD
Second Line	:
City	:	STOCKTON
State	:	MO
Zip	:	65785-8359
Country	:	US
Telephone Number	:	417-276-5500
Fax Number	:	417-876-3812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	03/12/2026

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