Provider Demographics
NPI:1851898456
Name:MAST, SHELBY (DO)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-858-8358
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:46 FAIRVIEW AVE STE 225
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976
Practice Address - Country:US
Practice Address - Phone:207-474-6265
Practice Address - Fax:207-474-8365
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3253208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics