Provider Demographics
NPI:1629457445
Name:MUSCO, SHELBY MARIE
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:MARIE
Last Name:MUSCO
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 1:5910 CLARK RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4856
Mailing Address - Country:US
Mailing Address - Phone:530-872-6328
Mailing Address - Fax:
Practice Address - Street 1:5910 CLARK RD
Practice Address - Street 2:SUITE I
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4856
Practice Address - Country:US
Practice Address - Phone:530-872-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health