Provider Demographics
NPI:1588676522
Name:SHIRRELL, AIMEE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:MARIE
Last Name:SHIRRELL
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:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-1245
Mailing Address - Country:US
Mailing Address - Phone:831-659-5125
Mailing Address - Fax:
Practice Address - Street 1:808 OAK AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927-5648
Practice Address - Country:US
Practice Address - Phone:831-674-5344
Practice Address - Fax:831-674-5214
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A734151Medicaid
CA00A734151Medicare ID - Type Unspecified
CAH40477Medicare UPIN