Provider Demographics
NPI:1104836048
Name:SHEDD, KELLY F (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:F
Last Name:SHEDD
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 1:2391 COURT DR STE 110
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2197
Mailing Address - Country:US
Mailing Address - Phone:704-866-0101
Mailing Address - Fax:704-866-0103
Practice Address - Street 1:2391 COURT DR STE 110
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2197
Practice Address - Country:US
Practice Address - Phone:704-866-0101
Practice Address - Fax:704-866-0103
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3315606Medicare ID - Type Unspecified
KYH51515Medicare UPIN