MEDICARE: SHELLI BRANSCOMB

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	1041C0700X	Clinical Social Worker	CW021240	PA

General Provider Information

NPI Number	:	1548991805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLI BRANSCOMB

Provider Business Mailing Address
First Line	:	5031 WAYNE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3641
Country	:	US
Telephone Number	:	917-399-3103
Fax Number	:

Provider Business Practice Location Address
First Line	:	5031 WAYNE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3641
Country	:	US
Telephone Number	:	917-399-3103
Fax Number	:

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

Provider Enumeration Date	:	06/18/2022
Last Update Date	:	06/18/2022

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Directions to “ SHELLI BRANSCOMB ” Practice Location

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