Healthcare Provider Details

I. General information

NPI: 1811791403
Provider Name (Legal Business Name): SHALYNE BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 HILLCREST DR
BELLEVUE NE
68005-3636
US

IV. Provider business mailing address

1807 LAIRD ST
OMAHA NE
68110-1744
US

V. Phone/Fax

Practice location:
  • Phone: 402-682-6599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: