MEDICARE: SHELBY NICOLE BEZERRA

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	163W00000X	Registered Nurse	4704330294	MI

General Provider Information

NPI Number	:	1255044095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY NICOLE BEZERRA

Provider Business Mailing Address
First Line	:	35545 REMINGTON DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4914
Country	:	US
Telephone Number	:	248-720-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	35545 REMINGTON DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4914
Country	:	US
Telephone Number	:	248-720-8960
Fax Number	:

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

Provider Enumeration Date	:	12/26/2022
Last Update Date	:	12/26/2022

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Directions to “ SHELBY NICOLE BEZERRA ” Practice Location

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