=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992950935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELOVE ANDOU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2008
-----------------------------------------------------
Last Update Date | 05/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 958 ALANDALE DR
-----------------------------------------------------
City | CHAMBERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17202-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-446-9140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 958 ALANDALE DR
-----------------------------------------------------
City | CHAMBERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17202-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-446-9140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW135853
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | BP00945081
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 19366
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------