Individual
SHELBY MAE VAN WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10100 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(800) 813-2000
Mailing address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(800) 813-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD225310
OR
207Q00000X
Family Medicine Physician
MD61684463
WA
Other
Enumeration date
04/14/2022
Last updated
07/30/2025
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