Provider Demographics
NPI:1689681967
Name:SANFORD, SHELBY P (MD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:P
Last Name:SANFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 AFFLINK PL STE 100
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2289
Mailing Address - Country:US
Mailing Address - Phone:205-366-9740
Mailing Address - Fax:205-344-9992
Practice Address - Street 1:1410 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2209
Practice Address - Country:US
Practice Address - Phone:205-345-8208
Practice Address - Fax:205-345-8209
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL109002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000008441Medicaid
AL051008441OtherBC TUSCALOOSA
AL114476Medicaid
AL051036886OtherBC WINFIELD
AL000036886Medicaid
AL051501876OtherBC JASAPER
AL114474Medicaid
AL114475Medicaid
AL114478Medicaid
AL009965020Medicaid
ALC76279Medicare UPIN
AL000036886Medicaid
AL102G703371Medicare Oscar/Certification
ALI600Medicare ID - Type UnspecifiedGROUP
ALF924Medicare ID - Type UnspecifiedGROUP
AL114478Medicaid
AL000008441Medicare ID - Type Unspecified
AL114475Medicaid
AL051036886OtherBC WINFIELD