Shaunda Elyse Kelly, MD, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5395 Issued in AL

Practice address

2000 6TH Ave S
Birmingham, AL 35233-2110

Phone

(205) 934-9999

NPI assigned

Feb 25, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Enrolled in AL, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renew You Health & Wellness LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Hoover, AL
  • NPI 1407530025
  Medicare reassignment NPD Authorized official
• Surgical & Sleep Solutions PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Orange City, FL
  • NPI 1558137604
  Medicare reassignment Authorized official
• University of Alabama Health Services Foundation, PC.

  • Multi-Specialty Clinic/Center
  • Birmingham, AL
  • NPI 1093768723
  Medicare reassignment NPD
• Regenerative Medical Institute for Pain & Neuropathy, LLC

  • Multi-Specialty Clinic/Center
  • Hoover, AL
  • NPI 1982110284
  NPD (past) Authorized official
• Randleman Family Clinic PLLC

  • Internal Medicine Physician
  • Greensboro, NC
  • NPI 1912419078
  NPD (past) Authorized official
• Surgical & Sleep Solutions PLLC

  • Customized Equipment (DME)
  • Orange City, FL
  • NPI 1427985225
  NPD (past) Authorized official
• Facial & Oral Surgical Solutions, PLLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Orange City, FL
  • NPI 1861807646

  Oral and Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331683200000",
    "number": "1659540508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55310",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352555310",
            "telephone_number": "205-731-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 6TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352332110",
            "telephone_number": "205-934-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHAUNDA",
        "middle_name": "ELYSE",
        "credential": "MD, DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-25",
        "last_updated": "2012-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "5395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051118224",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130496",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIVA",
            "identifier": "Z17060",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130492",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01281210",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130497",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051118219",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051118223",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051118226",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130494",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051118221",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130495",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Ann Kelly, LPC
• James Bernard Kelly, MD
• Kameron Kelly
• Kimberly Dionne Kelly, MSN, CRNP
• Matthew Kelly
• Stephen J Kelly, MD
• Daniel Kelmenson
• Edwin L Kelsey, M.D.
• Barbara Winter Kelsoe, PT
• Norman Keltner

• Oral and Maxillofacial Surgery (Dentist) in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.