Healthcare Provider Details

I. General information

NPI: 1124955836
Provider Name (Legal Business Name): SHELBY BREEDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KEITH ST SW STE 44
CLEVELAND TN
37311-5867
US

IV. Provider business mailing address

201 KEITH ST SW STE 44
CLEVELAND TN
37311-5867
US

V. Phone/Fax

Practice location:
  • Phone: 423-339-5586
  • Fax: 423-961-8103
Mailing address:
  • Phone: 423-339-5586
  • Fax: 423-961-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: