MEDICARE: MRS. RACHEL DAWNE SHELLEY B.S., ITDS

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	103T00000X	Psychologist		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487798724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL DAWNE SHELLEY B.S., ITDS

Provider Business Mailing Address
First Line	:	346 NW COLQUITT WAY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4854
Country	:	US
Telephone Number	:	386-752-6217
Fax Number	:

Provider Business Practice Location Address
First Line	:	346 NW COLQUITT WAY
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4854
Country	:	US
Telephone Number	:	386-752-6217
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	04/23/2008

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