Healthcare Provider Details

I. General information

NPI: 1700884319
Provider Name (Legal Business Name): SHELBY J BAKER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD SUITE 355
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

5255 E STOP 11 RD SUITE 440
INDIANAPOLIS IN
46237-6340
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-8420
  • Fax: 317-924-6785
Mailing address:
  • Phone: 317-882-2857
  • Fax: 317-882-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number28072072
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: