MEDICARE: SHELBY ALLEN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1922710359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY ALLEN

Provider Business Mailing Address
First Line	:	8650 CAINSVILLE PIKE
Second Line	:
City	:	LASCASSAS
State	:	TN
Zip	:	37085-4305
Country	:	US
Telephone Number	:	615-962-3054
Fax Number	:

Provider Business Practice Location Address
First Line	:	268 VETERANS PKWY
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37128-6431
Country	:	US
Telephone Number	:	629-207-6370
Fax Number	:

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

Provider Enumeration Date	:	12/16/2022
Last Update Date	:	12/16/2022

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