Healthcare Provider Details

I. General information

NPI: 1225270655
Provider Name (Legal Business Name): SHELLEY KAYE BALDASSANO PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S 17TH ST
LINCOLN NE
68502-3713
US

IV. Provider business mailing address

2201 S 17TH ST
LINCOLN NE
68502-3713
US

V. Phone/Fax

Practice location:
  • Phone: 402-441-7940
  • Fax:
Mailing address:
  • Phone: 402-441-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8763
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: