Provider Demographics
NPI:1063444644
Name:WEISENFELD, SHELLY RHODES (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:RHODES
Last Name:WEISENFELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLY
Other - Middle Name:MARIE
Other - Last Name:WEISENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:774 SHADES MOUNTAIN PLZ
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1513
Mailing Address - Country:US
Mailing Address - Phone:205-979-3381
Mailing Address - Fax:
Practice Address - Street 1:774 SHADES MOUNTAIN PLZ
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-1513
Practice Address - Country:US
Practice Address - Phone:205-979-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21225207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-96752OtherBCBS
AL106246Medicaid
AL1063444644OtherTRICARE SOUTH
AL515-96752OtherBCBS
ALP00713316Medicare PIN
AL510I930446Medicare PIN