Provider Demographics
NPI:1215515887
Name:COLLYMORE, SHELBY (DO)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:COLLYMORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2626 SOUTH CARRIER PKWY
Mailing Address - Street 2:ST. 300
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5014
Mailing Address - Country:US
Mailing Address - Phone:972-642-7337
Mailing Address - Fax:972-642-7339
Practice Address - Street 1:2626 SOUTH CARRIER PKWY
Practice Address - Street 2:STE. 300
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5014
Practice Address - Country:US
Practice Address - Phone:972-642-7337
Practice Address - Fax:972-642-7339
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXV1058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine