Most Relevant Information
Provider Data
| NPI Number: | 1003273939 |
| Provider Name: | SHANE KELLEHER PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 2628 |
Most Important Dates
| Enumeration Date: | 01/22/2016 |
| Last Updated: | 08/02/2016 |
Provider Practice Location
1500 COOPER ST
FORT WORTH
TX
761042710
Practice Location Phone/Fax
| Phone: | 6828857840 |
| Fax: | 6828857856 |
Provider Mailing Location
PO BOX 99371
FORT WORTH
TX
761990371
Provider Mailing Phone/Fax
| Phone: | 6828851855 |
| Fax: | 6828857347 |