MEDICARE: SHELLEY BAILEY MD

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	207Q00000X	Family Medicine Physician	21164	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00304367	OTHER	WV	MEDICARE-RR PROVIDER NUMBER

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750341814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY BAILEY MD

Provider Business Mailing Address
First Line	:	2585 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-1642
Country	:	US
Telephone Number	:	304-697-1396
Fax Number	:	304-697-2086

Provider Business Practice Location Address
First Line	:	3729 TEAYS VALLEY RD
Second Line	:	STE 100
City	:	HURRICANE
State	:	WV
Zip	:	25526-9705
Country	:	US
Telephone Number	:	304-760-6040
Fax Number	:	304-760-6042

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	11/12/2020

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Directions to “ SHELLEY BAILEY MD” Practice Location

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