MEDICARE: DR. SHELLEY M WAYNE HEALY D.P.M

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	213E00000X	Podiatrist	915	MN
2	213E00000X	Podiatrist	1593	TX

General Provider Information

NPI Number	:	1427002096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY M WAYNE HEALY D.P.M

Provider Business Mailing Address
First Line	:	2270 FORD PKWY STE 104
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3412
Country	:	US
Telephone Number	:	651-698-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 FORD PKWY STE 104
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3412
Country	:	US
Telephone Number	:	651-698-8879
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/20/2024

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