Provider Demographics
NPI:1750341814
Name:BAILEY, SHELLEY (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:3729 TEAYS VALLEY RD
Practice Address - Street 2:STE 100
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9705
Practice Address - Country:US
Practice Address - Phone:304-760-6040
Practice Address - Fax:304-760-6042
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511893Medicaid
WV1810211000Medicaid
WVP00304367OtherMEDICARE-RR PROVIDER NUMBER
KY64086408Medicaid
WV1810211000Medicaid
OH2511893Medicaid
WVWV2729AMedicare PIN
WVWV2729C604Medicare PIN