Provider Demographics
NPI:1689224362
Name:BUSCH, SHELBY JANE (DPM)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:JANE
Last Name:BUSCH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JANE
Other - Last Name:HATZINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM STUDENT
Mailing Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - Street 2:UNIT 33100
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:UNIT 33100
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:253-583-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
ORPG199450213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No171000000XOther Service ProvidersMilitary Health Care Provider