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General NPI Number Information
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NPI Number | 1861690422
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Entity Type | Individual
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Provider Name | DIANE C SHELBY M.ED.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 6515 S ROCKWELL ST
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City | CHICAGO
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State | IL
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Zip | 60629-1735
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Country | US
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Telephone | 773-737-2169
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Fax | 773-737-7226
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Provider Business Mailing Address
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Address Line | 6515 S ROCKWELL ST
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City | CHICAGO
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State | IL
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Zip | 60629-1735
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Country | US
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Telephone | 773-737-2169
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Fax | 773-737-7226
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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 | 2278S1500X
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Taxonomy Name | SNF/Subacute Care Certified Respiratory Therapist
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License Number | DS39630302P
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License Number State | IL
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