=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306070644
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MS. SHELVIE'S PROFESSIONAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2009
-----------------------------------------------------
Last Update Date | 05/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 UNION CHAPEL RD
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28372-9532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-258-5690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2511
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28372-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-258-5690
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TERRI SCOTT-MONEYHUN
-----------------------------------------------------
Credential | RHIT
-----------------------------------------------------
Telephone | 910-258-5685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------