MEDICARE: SHELLINE JEANTY LMSW

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	104100000X	Social Worker	115337	TX

General Provider Information

NPI Number	:	1144934050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLINE JEANTY LMSW

Provider Business Mailing Address
First Line	:	3622 TIVOLI DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 TIVOLI DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7228
Country	:	US
Telephone Number	:	860-710-4699
Fax Number	:

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

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	10/17/2025

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