Healthcare Provider Details

I. General information

NPI: 1144675786
Provider Name (Legal Business Name): MERCEDES SHELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20730 VALLEY GREEN DR
CUPERTINO CA
95014-1704
US

IV. Provider business mailing address

21030 ORCHID DR
CALIFORNIA CITY CA
93505-2015
US

V. Phone/Fax

Practice location:
  • Phone: 408-783-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4040057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: