| NPI | 1649808817 |
|---|---|
| Former Name | SHELBY DIANE ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: CT 77342) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 1.077342) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-07-24 |