MEDICARE: SHELLEY PHILLIPS BANDY CMF,CMF,COF

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	332BC3200X	Customized Equipment (DME)	C51438	NC
2	332B00000X	Durable Medical Equipment & Medical Supplies	C51438	NC
3	332BD1200X	Dialysis Equipment & Supplies (DME)	C51438	NC
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	C51438	NC
5	332BX2000X	Oxygen Equipment & Supplies (DME)	C51438	NC
6	335E00000X	Prosthetic/Orthotic Supplier	C51438	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1295280139	OTHER	NC	BLUE CROSS AND BLUE SHIELD NC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1295280139	OTHER	NC	BLUE CROSS AND BLUE SHIELD SC

General Provider Information

NPI Number	:	1295139913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY PHILLIPS BANDY CMF,CMF,COF

Provider Business Mailing Address
First Line	:	306 PENNY LN
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4306
Country	:	US
Telephone Number	:	252-773-0904
Fax Number	:	252-565-1733

Provider Business Practice Location Address
First Line	:	306 PENNY LN
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4306
Country	:	US
Telephone Number	:	252-773-0904
Fax Number	:	252-565-1733

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

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	02/10/2017

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