Provider Demographics
NPI:1083170997
Name:DANIEL, SHELBY
Entity Type:Individual
Prefix:MR
First Name:SHELBY
Middle Name:
Last Name:DANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-8837
Mailing Address - Country:US
Mailing Address - Phone:229-432-2781
Mailing Address - Fax:
Practice Address - Street 1:2700 QUAIL RUN DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-8837
Practice Address - Country:US
Practice Address - Phone:229-432-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health