Provider Demographics
NPI:1447259643
Name:RAY, SHELLEY H (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:H
Last Name:RAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1419 HAMRIC DR E STE 101
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2174
Practice Address - Country:US
Practice Address - Phone:256-235-3660
Practice Address - Fax:256-235-3663
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.23813207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503704Medicaid
AL03704OtherBCBS OF AL PROVIDER #
AL051503704Medicaid
ALG85938Medicare UPIN