Provider Demographics
NPI:1265963458
Name:MO, SHELLEY XINRAN (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:XINRAN
Last Name:MO
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 1:485 ROYER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5102
Mailing Address - Country:US
Mailing Address - Phone:717-560-4020
Mailing Address - Fax:
Practice Address - Street 1:485 ROYER DR STE 103
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5102
Practice Address - Country:US
Practice Address - Phone:717-560-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD473423207WX0009X
PAMT215770207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist