MEDICARE: NICOLE C SHELL

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	246ZC0007X	Surgical Assistant		AZ

General Provider Information

NPI Number	:	1205761632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE C SHELL

Provider Business Mailing Address
First Line	:	5051 W CAMINO DE MANANA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8835
Country	:	US
Telephone Number	:	303-968-7838
Fax Number	:

Provider Business Practice Location Address
First Line	:	5051 W CAMINO DE MANANA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-8835
Country	:	US
Telephone Number	:	303-968-7838
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ NICOLE C SHELL ” Practice Location

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