MEDICARE: ANDREW SHELBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	61599	KS

General Provider Information

NPI Number	:	1003357146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SHELBY

Provider Business Mailing Address
First Line	:	4505 W 6TH ST STE B
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4895
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4505 W 6TH ST STE B
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4895
Country	:	US
Telephone Number	:	785-841-1188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	04/29/2026

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