DR. SHELLEY K WATTERS (NPI# 1407963457) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1407963457 |
Entity Type | Individual |
Full Name | DR. SHELLEY K WATTERS |
Credential | MD |
Practice Address |
1055 N Mayfair Rd Wauwatosa WI 53226-3436 |
Mailing Address |
3301 W Forest Home Ave Milwaukee WI 53215-2843 |
Practice Telephone | 4144792300 |
Mailing Telephone | 4146476326 |
Mailing Fax Number | 4146718860 |
Enumeration Date | 2006-08-24 |
Last Update Date | 2020-05-29 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RA0201X |
Internal Medicine Specialization: Allergy & Immunology |
3394 | WI | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
DEA NUMBER | BW2916748 | 01 | |
WI | 31931600 | 05 |
Street Address |
1055 N MAYFAIR RD |
City | WAUWATOSA |
State | WI |
Zip Code | 53226-3436 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356797609 | Khyati Soni | Family Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2016-05-05 |
1255772190 | Savan Panchal | Family Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2013-07-08 |
1487999074 | Beth E. Stay | Nurse Practitioner | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2012-12-07 |
1114287513 | Daniel Molinaro | Family Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2012-05-21 |
1871804757 | Dheeraj Reddy | Internal Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226 | 2010-06-25 |
1801127386 | Aurora Advanced Healthcare, Inc. | Non-Pharmacy Dispensing Site | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2010-01-22 |
1689860132 | Oncology Alliance, S.c. | Internal Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2007-09-19 |
1760531818 | William Shaffer | Family Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2007-01-09 |
1447309786 | Mark H Hermanoff | Internal Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2007-01-09 |
1417038381 | Sara J Nolan | Family Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2006-10-18 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912511155 | Alexander Harlan | Pharmacist | 900 N 92nd St, Milwaukee, WI 53226 | 2020-09-04 |
1558985762 | Armghan Haider Ans | Student in an Organized Health Care Education/Training Program | 9200 W. Wisconsin Ave. Froedtert Hospital & Medical Col, Milwaukee, WI 53226 | 2020-06-03 |
1669001103 | Kimberly Tyler | Student in an Organized Health Care Education/Training Program | 8701 W Watertown Plank Road, Medical College of Wisconsin Dept of Internal Medicine, Wauwatosa, WI 53226 | 2020-04-06 |
1972131993 | Francesca Meloy Devine | Student in an Organized Health Care Education/Training Program | Medical Education Office: Children's Corporate Center, 999 N. 92nd St., Suite 730, Milwaukee, WI 53226 | 2020-03-27 |
1285275248 | Sharitta Alford | Technician | 12250 West North Avenue, Apartment 142b, Wauwatosa, WI 53226 | 2019-10-01 |
1619528023 | Linda Marie Sabatinelli | Technician | 12107 W. Woodland Ave, Wauwatosa, WI 53226 | 2019-09-26 |
1598310195 | Matthew Laviolette | Surgery | Medical College of Wisconsin, 8701 Watertown Plank Rd., Surgical Oncology, Milwaukee, WI 53226 | 2019-08-09 |
1962056432 | Lyndsey Marie Bratberg | Physician Assistant | F&mcw Clinical Cancer Center 9200 W. Wisconsin Ave., Milwaukee, WI 53226 | 2019-08-01 |
1659832855 | Benjamin David Seadler | Surgery | Mcw, Department of Surgery, 8701 Watertown Plank Road, Milwaukee, WI 53226 | 2019-03-29 |
1861953267 | Michael Dryden | Student in an Organized Health Care Education/Training Program | 8701 Watertown Plank Rd., Milwaukee, WI 53226 | 2019-03-27 |
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Taxonomy Code | 207RA0201X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Allergy & Immunology |
An internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Special Qualifications in the field of Allergy & Immunology. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1447309786 | Mark H Hermanoff | Internal Medicine | 1055 N Mayfair Rd, Wauwatosa, WI 53226-3436 | 2007-01-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1306140439 | Jared I Darveaux | Internal Medicine | 311 Gundersen Dr, Onalaska, WI 54650 | 2011-01-04 |
1285841155 | Nathan M Lebak | Internal Medicine | 252 Mchenry St Ste 8, Burlington, WI 53105-1828 | 2007-05-17 |
1861468712 | Robert J Kriz | Internal Medicine | 9013 Bentley Grn, Verona, WI 53593-7858 | 2006-02-28 |
1053739714 | David L Peloza | Internal Medicine | 1821 S Stoughton Rd, Madison, WI 53716-2257 | 2014-03-31 |
1154616795 | Ashvini Varadhi Biswas | Internal Medicine | 10400 75th St, Kenosha, WI 53142-7884 | 2011-06-11 |
1770885220 | Serenity Health Care Center Sc | Internal Medicine | 2607 N Grandview Blvd, Waukesha, WI 53188-1686 | 2010-12-03 |
1285800367 | Wayne Harry Konetzki | Internal Medicine | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2008-05-07 |
1073543096 | Anita I Gheller-rigoni | Internal Medicine | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2006-07-04 |
1326084534 | Ravi Viswanathan | Internal Medicine | 451 Junction Rd, Madison, WI 53717-2656 | 2006-06-22 |
1598711665 | Monica Vasudev | Internal Medicine | 2414 Kohler Memorial Dr, Sheboygan, WI 53081-3129 | 2006-05-26 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.