Provider Demographics
NPI:1689791949
Name:FELTON, SHAILI KHANDHERIA (MD)
Entity Type:Individual
Prefix:
First Name:SHAILI
Middle Name:KHANDHERIA
Last Name:FELTON
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 1:10208 QUAKER AVE
Mailing Address - Street 2:STE 200B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8394
Mailing Address - Country:US
Mailing Address - Phone:806-712-9007
Mailing Address - Fax:806-712-0247
Practice Address - Street 1:10208 QUAKER AVE STE 200B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8394
Practice Address - Country:US
Practice Address - Phone:806-712-9007
Practice Address - Fax:806-712-0247
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7421207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178935100OtherFIRSTCARE
NM47572728Medicaid
TX218583701Medicaid
TX8CR061OtherBCBS
TXTXB113728Medicare PIN