MEDICARE: SARA LYN 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	163W00000X	Registered Nurse	2492806	MN

General Provider Information

NPI Number	:	1295547552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA LYN SHELL

Provider Business Mailing Address
First Line	:	4801 VETERANS DR
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-2015
Country	:	US
Telephone Number	:	320-252-1670
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 42ND AVE S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-5489
Country	:	US
Telephone Number	:	320-310-5841
Fax Number	:

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

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	09/04/2025

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Directions to “ SARA LYN SHELL ” Practice Location

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