MEDICARE: SHELBY CHANDLER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1316075427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBY CHANDLER

Provider Business Mailing Address
First Line	:	2935 KING ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2129
Country	:	US
Telephone Number	:	510-847-9144
Fax Number	:

Provider Business Practice Location Address
First Line	:	2935 KING ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2129
Country	:	US
Telephone Number	:	510-847-9144
Fax Number	:

Authorized Official
Title or Position	:	INTERN COUNSELOR
Name	:	MISS SHELBY ELIZABETH CHANDLER
Credential	:
Telephone Number	:	510-847-9144

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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Directions to “SHELBY CHANDLER ” Practice Location

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