# BENJAMIN SHETTELL, MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689944530
- **Authorized official:** AMANDA KAYE HARRIS (OFFICE MANAGER)
- **Authorized official phone:** (530) 242-1227

## Contact information

- **Practice address:** 2632 EDITH AVE STE B, REDDING, CA 96001-3031
- **Practice address phone:** (530) 242-1227
- **Practice address fax:** (530) 242-6078
- **Mailing address:** 2632 EDITH AVE STE B, REDDING, CA 96001-3031
- **Mailing address phone:** (530) 242-1227
- **Mailing address fax:** (530) 242-6078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A106932 | CA | Yes |

## Other

- **Enumeration date:** 01/10/2012
- **Last updated:** 01/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5774539 | MEDI-CAL PIN NUMBER | CA |
| 01 | — | DX169A | MEDICARE PTAN | — |