Provider Demographics
NPI:1245800861
Name:BATES, SHELBY C
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:C
Last Name:BATES
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 1:1297 HIGH ST APT 208B
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8241
Mailing Address - Country:US
Mailing Address - Phone:330-242-0039
Mailing Address - Fax:
Practice Address - Street 1:1297 HIGH ST APT 208B
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8241
Practice Address - Country:US
Practice Address - Phone:330-242-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care