Provider Demographics
NPI:1700257821
Name:GUNNELS, SHELBI SARAE
Entity Type:Individual
Prefix:MRS
First Name:SHELBI
Middle Name:SARAE
Last Name:GUNNELS
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 1:1111 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76932-3513
Mailing Address - Country:US
Mailing Address - Phone:325-884-2016
Mailing Address - Fax:
Practice Address - Street 1:1111 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:TX
Practice Address - Zip Code:76932-3513
Practice Address - Country:US
Practice Address - Phone:325-884-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115966235Z00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program