Provider Demographics
NPI:1528599214
Name:LEGEROS, SHELBY (MD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:LEGEROS
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 1:1535 TARAVAL ST APT 402
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2368
Mailing Address - Country:US
Mailing Address - Phone:808-284-4797
Mailing Address - Fax:
Practice Address - Street 1:3708 WATSEKA AVE APT 320
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4094
Practice Address - Country:US
Practice Address - Phone:808-284-4797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine