Provider Demographics
NPI:1326688383
Name:SHRADER, SHELBY ANN (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:ANN
Last Name:SHRADER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:ANN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6391 DAYTONA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-7239
Mailing Address - Country:US
Mailing Address - Phone:540-222-9627
Mailing Address - Fax:
Practice Address - Street 1:16620 40TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55446-2687
Practice Address - Country:US
Practice Address - Phone:563-249-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist