Provider Demographics
NPI:1164106092
Name:BAILEY, SHELLIE LAVON
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:LAVON
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SOURWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7899
Mailing Address - Country:US
Mailing Address - Phone:614-348-7788
Mailing Address - Fax:
Practice Address - Street 1:104 SOURWOOD ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7899
Practice Address - Country:US
Practice Address - Phone:614-348-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR067650376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker