Healthcare Provider Details

I. General information

NPI: 1417888165
Provider Name (Legal Business Name): SHELBY POOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30078 N 71ST AVE
PEORIA AZ
85383-3051
US

IV. Provider business mailing address

30078 N 71ST AVE
PEORIA AZ
85383-3051
US

V. Phone/Fax

Practice location:
  • Phone: 480-825-8901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: