Provider Demographics
NPI:1871530147
Name:SHELLY, WENDY B (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:B
Last Name:SHELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:CLOSSHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8010 FROST STREET
Mailing Address - Street 2:PLAZA LEVEL
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-505-5500
Mailing Address - Fax:858-505-5555
Practice Address - Street 1:8010 FROST ST
Practice Address - Street 2:PLAZA LEVEL
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2778
Practice Address - Country:US
Practice Address - Phone:858-505-5500
Practice Address - Fax:858-505-5555
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90649207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A906490Medicaid
CAI30609Medicare UPIN
CA00A906490Medicare PIN