Provider Demographics
NPI:1841017043
Name:SHELBY, BAILEY BENSON
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:BENSON
Last Name:SHELBY
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 1:2504 RANDOLPH PL
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1130
Mailing Address - Country:US
Mailing Address - Phone:251-278-7752
Mailing Address - Fax:
Practice Address - Street 1:2504 RANDOLPH PL
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-1130
Practice Address - Country:US
Practice Address - Phone:251-278-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL-309862163WL0100X
AL1-171619163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse