Provider Demographics
NPI:1922359546
Name:SHELBY NATUROPATHY, PLLC
Entity Type:Organization
Organization Name:SHELBY NATUROPATHY, PLLC
Other - Org Name:VILLAGE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:JOHNIE
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LM
Authorized Official - Phone:206-919-0175
Mailing Address - Street 1:5600 14TH AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3723
Mailing Address - Country:US
Mailing Address - Phone:206-919-0175
Mailing Address - Fax:206-567-9797
Practice Address - Street 1:5600 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3723
Practice Address - Country:US
Practice Address - Phone:206-919-0175
Practice Address - Fax:206-567-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9999999261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty