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Individual

SHAUNDA ELYSE KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD, DMD

Contact information

Practice address
2000 6TH AVE S, BIRMINGHAM, AL 35233-2110
(205) 934-9999
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
5395
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01281210
MS
01
051118219
BCBS
AL
01
051118221
BCBS
AL
01
051118223
BCBS
AL
01
051118224
BCBS
AL
01
051118226
BCBS
AL
05
130492
AL
05
130494
AL
05
130495
AL
05
130496
AL
05
130497
AL
01
Z17060
VIVA
AL
Enumeration date
02/25/2008
Last updated
03/14/2012
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