# DR. SHELLEY L BLACKBURN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750327565
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 35057267 | OH | Yes |
| 207Q00000X | Family Medicine Physician | 35057267B | OH | — |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 05/25/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000251080 | ANTHEM | — |
| 05 | — | 0768745 | — | OH |
| 01 | — | 080193046 | MEDICARE RAILROAD | — |