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General NPI Number Information
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NPI Number | 1346944477
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Entity Type | Individual
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Provider Name | SHELBY CARRILLO
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Gender | Female
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 1320 WINDRIDGE RD
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City | FRIENDSVILLE
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State | TN
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Zip | 37737
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Country | US
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Telephone | 855-832-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 200 PROSPERITY DR
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City | KNOXVILLE
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State | TN
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Zip | 37923-4718
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Country | US
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Telephone | 855-832-6727
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT23263366
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 8568
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License Number State | TN
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