Provider Demographics
NPI:1164528535
Name:RILEY, SHELLY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:LYNN
Last Name:RILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3660 STONERIDGE RD
Mailing Address - Street 2:BLDG F101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7760
Mailing Address - Country:US
Mailing Address - Phone:512-329-8222
Mailing Address - Fax:512-329-0087
Practice Address - Street 1:3660 STONERIDGE RD
Practice Address - Street 2:BLDG F101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7760
Practice Address - Country:US
Practice Address - Phone:512-329-8222
Practice Address - Fax:512-329-0087
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL81712084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9025Medicare ID - Type Unspecified
TXH43438Medicare UPIN