Provider Demographics
NPI:1679106454
Name:SHELBY THE RD
Entity Type:Organization
Organization Name:SHELBY THE RD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:972-821-9557
Mailing Address - Street 1:5301 ALPHA RD STE 80-23
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4355
Mailing Address - Country:US
Mailing Address - Phone:972-821-9557
Mailing Address - Fax:972-525-4731
Practice Address - Street 1:5301 ALPHA RD STE 80-23
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4355
Practice Address - Country:US
Practice Address - Phone:972-821-9557
Practice Address - Fax:972-525-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health