Provider Demographics
NPI:1831368638
Name:COWAN, SHELLEY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:MARIE
Last Name:COWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:MARIE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:221 E HACIENDA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6625
Mailing Address - Country:US
Mailing Address - Phone:408-376-3350
Mailing Address - Fax:408-374-4130
Practice Address - Street 1:221 E HACIENDA AVE STE B
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-6625
Practice Address - Country:US
Practice Address - Phone:408-376-3350
Practice Address - Fax:408-374-4130
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101415208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFM134YMedicare PIN