Provider Demographics
NPI:1174793111
Name:BANSAL, SHELLY (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:445 N SILVERBELL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2686
Mailing Address - Country:US
Mailing Address - Phone:520-396-1370
Mailing Address - Fax:520-396-1375
Practice Address - Street 1:802 N RIVERSIDE RD STE 210
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2509
Practice Address - Country:US
Practice Address - Phone:816-271-6200
Practice Address - Fax:816-271-6749
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2024-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2022044341208G00000X
OH35.096003208G00000X, 208G00000X
AZ60178208G00000X
FLME120939208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)