Provider Demographics
NPI:1336455039
Name:MILLER, SHELBY MCNEEL (SHELBY MILLER, CCP)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:MCNEEL
Last Name:MILLER
Suffix:
Gender:F
Credentials:SHELBY MILLER, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HALCYON PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3825
Mailing Address - Country:US
Mailing Address - Phone:210-826-0631
Mailing Address - Fax:210-977-0543
Practice Address - Street 1:210 HALCYON PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3825
Practice Address - Country:US
Practice Address - Phone:210-325-4239
Practice Address - Fax:210-977-0543
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0208242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist