Provider Demographics
NPI:1033103577
Name:SHELLENBERGER, PAUL T (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:SHELLENBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-5413
Mailing Address - Country:US
Mailing Address - Phone:717-854-4035
Mailing Address - Fax:717-845-6556
Practice Address - Street 1:1422 W MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-5413
Practice Address - Country:US
Practice Address - Phone:717-854-4035
Practice Address - Fax:717-845-6556
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003681L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98638Medicare UPIN
SH99461Medicare ID - Type Unspecified