Provider Demographics
NPI:1053439802
Name:KENDALL, SHELLIE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLIE
Middle Name:MARIE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CAROLINA BAY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2041
Mailing Address - Country:US
Mailing Address - Phone:910-662-8888
Mailing Address - Fax:910-662-8909
Practice Address - Street 1:510 CAROLINA BAY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2041
Practice Address - Country:US
Practice Address - Phone:910-662-8888
Practice Address - Fax:910-662-8909
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1126602080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program