Donovan Paul Shively, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

G21888 Issued in CA

Practice address

4397 Edinburg CT
Fairfield, CA 94534

Phone

(707) 864-2311

Fax

(707) 864-2317

NPI assigned

Feb 8, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254960000000",
    "number": "1063485217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4397 EDINBURG CT",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "94534",
            "telephone_number": "707-864-2311",
            "fax_number": "707-864-2317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4397 EDINBURG CT",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "94534",
            "telephone_number": "707-864-2311",
            "fax_number": "707-864-2317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "DONOVAN",
        "middle_name": "PAUL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2009-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G21888",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G218880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dickyi Sherab
• Leeann Shigekawa, LCSW
• Lauryn Shipp
• Cecilia Anne Shipps, PT
• Darlinda Lea Shirmard, N.P.
• Nadin Shoufi, CPBMT
• Camilia Kaye Shoulders, M.S.
• Kathleen Sianghio, NP
• Bernard Siao
• Shannon Rose Sickle, FNP

• Obstetrics & Gynecology Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.