Provider Demographics
NPI:1184820953
Name:DURHAM, SHELLEY ERIN (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ERIN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:ERIN
Other - Last Name:HAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0836
Mailing Address - Country:US
Mailing Address - Phone:817-966-8550
Mailing Address - Fax:817-612-3261
Practice Address - Street 1:5120 CONCHOS TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-3024
Practice Address - Country:US
Practice Address - Phone:817-966-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine