Provider Demographics
NPI:1417479171
Name:NASTALA, SHELBY (APSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:NASTALA
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 ODANA RD STE 20
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1130
Mailing Address - Country:US
Mailing Address - Phone:608-449-2344
Mailing Address - Fax:
Practice Address - Street 1:6333 ODANA RD STE 20
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1130
Practice Address - Country:US
Practice Address - Phone:608-449-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42222800Medicaid