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General NPI Number Information
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NPI Number | 1629710397
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Entity Type | Individual
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Provider Name | MANDY SUE SHELLEY DO
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Gender | Female
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 3615 E JOHN ROWAN BLVD STE 104
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City | BARDSTOWN
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State | KY
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Zip | 40004-3264
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Country | US
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Telephone | 502-348-5968
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Fax | 270-706-5802
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Provider Business Mailing Address
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Address Line | 366 RADERS VALLEY RD
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City | WILLIAMSBURG
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State | WV
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Zip | 24991-7008
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Country | US
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Telephone | 502-348-5968
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 06008
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License Number State | KY
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