Provider Demographics
NPI:1952974487
Name:NORTHUP, SHELBY JEAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:JEAN
Last Name:NORTHUP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37805
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-7805
Mailing Address - Country:US
Mailing Address - Phone:410-266-3900
Mailing Address - Fax:410-266-0522
Practice Address - Street 1:2002 MEDICAL PKWY STE 230
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3282
Practice Address - Country:US
Practice Address - Phone:410-266-3900
Practice Address - Fax:410-266-9245
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01563231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist