MEDICARE: GRACE D SHELBY PHD

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	103TC0700X	Clinical Psychologist	7070	OH

General Provider Information

NPI Number	:	1316132111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE D SHELBY PHD

Provider Business Mailing Address
First Line	:	5899 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1651
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5899 HARRISON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-1651
Country	:	US
Telephone Number	:	513-803-8103
Fax Number	:

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

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	05/06/2015

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Directions to “ GRACE D SHELBY PHD” Practice Location

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