Provider Demographics
NPI:1558896126
Name:HOLLAND, SHELBY ANDERSON (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:ANDERSON
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:NICOLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 7042
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:309-655-7257
Mailing Address - Fax:
Practice Address - Street 1:1303 AZALEA COURT
Practice Address - Street 2:SUITE B
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-692-0570
Practice Address - Fax:843-692-7641
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO879502085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology