Provider Demographics
NPI:1134154156
Name:SHELBURNE, PAUL V (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:V
Last Name:SHELBURNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 BENTWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6907
Mailing Address - Country:US
Mailing Address - Phone:505-453-9095
Mailing Address - Fax:505-727-4505
Practice Address - Street 1:1027 BENTWATER PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6907
Practice Address - Country:US
Practice Address - Phone:505-453-9095
Practice Address - Fax:505-727-4505
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-142207V00000X
TXG0107207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13618Medicaid
NM485887YR41Medicare PIN
F39461Medicare UPIN