Provider Demographics
NPI:1033345962
Name:LAZARO, SHELLEY SALES (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:SALES
Last Name:LAZARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 CURIE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2909
Mailing Address - Country:US
Mailing Address - Phone:915-532-2985
Mailing Address - Fax:915-577-9315
Practice Address - Street 1:1733 CURIE DR STE 103
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2909
Practice Address - Country:US
Practice Address - Phone:915-532-2985
Practice Address - Fax:915-577-9315
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034710390200000X
TXP5545208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program