MEDICARE: MS. SHALITHA SHELBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker
3	251S00000X	Community/Behavioral Health Agency
4	311ZA0620X	Adult Care Home Facility
5	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
6	320800000X	Mental Illness Community Based Residential Treatment Facility
7	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
8	343900000X	Non-emergency Medical Transport (VAN)
9	347C00000X	Private Vehicle
10	385H00000X	Respite Care
11	385HR2050X	Respite Care Camp
12	385HR2050X	Respite Care Camp	TX
13	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
14	385HR2065X	Child Physical Disabilities Respite Care

General Provider Information

NPI Number	:	1588968895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHALITHA SHELBY

Provider Business Mailing Address
First Line	:	PO BOX 1334
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76101-1334
Country	:	US
Telephone Number	:	817-729-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3917 ORLANDO SPRINGS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1485
Country	:	US
Telephone Number	:	817-729-1150
Fax Number	:

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

Provider Enumeration Date	:	12/29/2010
Last Update Date	:	10/12/2012

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