Shelby Victoria Anderson, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Portland, OR
NPI 1780155721 · NPPES record last updated Apr 14, 2025
Key facts
- NPI
- 1780155721
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 3181 SW Sam Jackson Park Rd
Portland, OR 97239-3098 - Phone
- (503) 494-8211
- NPI assigned
- Dec 17, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240917001139 | OR | Order and Referring Only - Family Practice |
0547701658 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Transitional Resources | Past | Accepting new patients |
Interoperability endpoints
- sanderson172263@direct.ohsu.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3098
Mailing address
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Other providers in Portland, OR
- Sandra C Anderson
- Scott Anderson
- Shannon Donovan Anderson
- Sharon Anderson
- Shea Landon Anderson
- Susan Anderson
- Suzannah Anderson
- Sydney Elyse Anderson
- Taylor Anderson
- Terra Anderson
All providers in Portland, OR · Student in an Organized Health Care Education/Training Program in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.