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General NPI Number Information
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NPI Number | 1144675786
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Entity Type | Individual
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Provider Name | MERCEDES SHELLEY
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Gender | Female
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 20730 VALLEY GREEN DR
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City | CUPERTINO
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State | CA
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Zip | 95014-1704
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Country | US
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Telephone | 408-783-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 21030 ORCHID DR
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City | CALIFORNIA CITY
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State | CA
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Zip | 93505-2015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | A-4040057
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License Number State | CA
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