MEDICARE: SHELBY STOGSDILL

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	103K00000X	Behavior Analyst	1-21-47956	IN

General Provider Information

NPI Number	:	1265106637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY STOGSDILL

Provider Business Mailing Address
First Line	:	590 MISSOURI AVE STE 204
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3084
Country	:	US
Telephone Number	:	812-288-4688
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 MISSOURI AVE STE 204
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3084
Country	:	US
Telephone Number	:	812-288-4688
Fax Number	:

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

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	08/09/2021

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Directions to “ SHELBY STOGSDILL ” Practice Location

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