Provider Demographics
NPI:1164666228
Name:MORRISROE, SHELBY NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:NICOLE
Last Name:MORRISROE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:20911 EARL ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4352
Mailing Address - Country:US
Mailing Address - Phone:310-542-0199
Mailing Address - Fax:310-542-0829
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 140
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-542-0199
Practice Address - Fax:310-542-4652
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2023-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA106800208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE381ZMedicare PIN