Healthcare Provider Details

I. General information

NPI: 1073430849
Provider Name (Legal Business Name): SHELBY NOEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3797 OSAGE BEACH PKWY
OSAGE BEACH MO
65065-2186
US

IV. Provider business mailing address

PO BOX 1666
LAKE OZARK MO
65049-1666
US

V. Phone/Fax

Practice location:
  • Phone: 573-336-1970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2026027601
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: