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General NPI Number Information
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NPI Number | 1699335067
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Entity Type | Individual
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Provider Name | SHELLY TAT DO
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 2626 ALEXANDRIA PIKE
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City | HIGHLAND HEIGHTS
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State | KY
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Zip | 41076-1530
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Country | US
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Telephone | 859-781-4111
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Fax | 859-441-5214
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Provider Business Mailing Address
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Address Line | 2626 ALEXANDRIA PIKE
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City | HIGHLAND HEIGHTS
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State | KY
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Zip | 41076-1530
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Country | US
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Telephone | 859-781-4111
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Fax | 859-441-5214
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 05196
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License Number State | KY
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Taxonomy #2
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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 #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05196
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License Number State | KY
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