Provider Demographics
NPI:1285642264
Name:GOODWEIN, SHELLEY N (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:N
Last Name:GOODWEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:831-649-1000
Mailing Address - Fax:
Practice Address - Street 1:1756 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-5103
Practice Address - Country:US
Practice Address - Phone:831-443-8200
Practice Address - Fax:831-449-3493
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G717900Medicaid
CA1316905136OtherSALINAS WOMEN'S CARE INC.
F87961Medicare UPIN
CA00G717900Medicaid