MEDICARE: BAILEY SHEGGEBY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1528682515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY SHEGGEBY

Provider Business Mailing Address
First Line	:	710 LINCOLN AVE
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	181 WHIPPLE ST
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1705
Country	:	US
Telephone Number	:	320-583-8948
Fax Number	:

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

Provider Enumeration Date	:	06/04/2020
Last Update Date	:	06/04/2020

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Directions to “ BAILEY SHEGGEBY ” Practice Location

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