Provider Demographics
NPI:1760746036
Name:DANIELS, SHELLY CHRISTINE (OD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:CHRISTINE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:CHRISTINE
Other - Last Name:TALMADGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9004 FOREST XING
Mailing Address - Street 2:STE A
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1193
Mailing Address - Country:US
Mailing Address - Phone:281-797-1839
Mailing Address - Fax:
Practice Address - Street 1:9004 FOREST XING
Practice Address - Street 2:SUITE A
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1197
Practice Address - Country:US
Practice Address - Phone:281-364-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7963T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist