Provider Demographics
NPI:1295240356
Name:BAMBRICK, SHELBBY
Entity type:Individual
Prefix:
First Name:SHELBBY
Middle Name:
Last Name:BAMBRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W WINTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1136
Mailing Address - Country:US
Mailing Address - Phone:510-951-1632
Mailing Address - Fax:
Practice Address - Street 1:313 W WINTON AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1136
Practice Address - Country:US
Practice Address - Phone:510-951-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
CAASW81250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool