Provider Demographics
NPI:1700975398
Name:SHELLOCK, JESSICA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEIGH
Last Name:SHELLOCK
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 1:6020 W PARKER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8172
Mailing Address - Country:US
Mailing Address - Phone:972-473-3947
Mailing Address - Fax:
Practice Address - Street 1:6020 W PARKER RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8172
Practice Address - Country:US
Practice Address - Phone:972-608-5000
Practice Address - Fax:972-473-3929
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9650207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9650OtherTEXAS MEDICAL LICENSE