Healthcare Provider Details

I. General information

NPI: 1720919707
Provider Name (Legal Business Name): SHELBY DANIELS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 CANTRALL CREEK RD
CANTRALL IL
62625-8785
US

IV. Provider business mailing address

2980 CANTRALL CREEK RD
CANTRALL IL
62625-8785
US

V. Phone/Fax

Practice location:
  • Phone: 217-502-0171
  • Fax:
Mailing address:
  • Phone: 217-502-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: