MEDICARE: SCHUYLER SHELLONER

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	146N00000X	Basic Emergency Medical Technician	E096385	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E3019741	OTHER	CA	NREMT REGISTRY NUMBER
2	E096385	OTHER	CA	NORTHERN CALIFORNIA EMT REGISTRY NUMBER

General Provider Information

NPI Number	:	1508222753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCHUYLER SHELLONER

Provider Business Mailing Address
First Line	:	1416 N FOREST ST APT 201
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1482 SLATER RD STE A
Second Line	:
City	:	FERNDALE
State	:	WA
Zip	:	98248-8919
Country	:	US
Telephone Number	:	360-380-3144
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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Directions to “ SCHUYLER SHELLONER ” Practice Location

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