Provider Demographics
NPI:1881465417
Name:PHILYAW, SHELBY
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:PHILYAW
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 1:4435 SWEETENS COVE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-6429
Mailing Address - Country:US
Mailing Address - Phone:423-463-8216
Mailing Address - Fax:
Practice Address - Street 1:201 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1497
Practice Address - Country:US
Practice Address - Phone:423-463-8216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist