MEDICARE: SHANEL POOLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		IN

General Provider Information

NPI Number	:	1063378065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANEL POOLE

Provider Business Mailing Address
First Line	:	PO BOX 88321
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-0321
Country	:	US
Telephone Number	:	317-500-2800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3720 N EUCLID AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-1518
Country	:	US
Telephone Number	:	317-500-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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Directions to “ SHANEL POOLE ” Practice Location

Language	Start Address	Practice Location

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