Provider Demographics
NPI:1801381215
Name:PAYNE, SHELBY FAITH (MD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:FAITH
Last Name:PAYNE
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 1:4015 INTERSTATE 45 N STE 100
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5076
Mailing Address - Country:US
Mailing Address - Phone:936-270-4600
Mailing Address - Fax:936-856-8429
Practice Address - Street 1:4015 INTERSTATE 45 N STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5076
Practice Address - Country:US
Practice Address - Phone:936-270-4600
Practice Address - Fax:936-856-8429
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8751207Q00000X
TXBP10063381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX425448401Medicaid