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NPI Code Detail

MEDICARE: ELIZABETH SHELLEY

MEDICARE: ELIZABETH SHELLEY
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
1103K00000XBehavior Analyst1-21-52150SC
2106S00000XBehavior Technician17-34049SC

General Provider Information

NPI Number : 1285132498
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH SHELLEY
Provider Business Mailing Address
First Line : PO BOX 931142
Second Line :
City : ATLANTA
State : GA
Zip : 31193-1142
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1345 COMPANION CT STE 702
Second Line :
City : SUMTER
State : SC
Zip : 29150-1749
Country : US
Telephone Number : 803-905-5107
Fax Number : 615-815-1946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2018
Last Update Date : 08/29/2024

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Directions to “ ELIZABETH SHELLEY ” Practice Location

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