MEDICARE: SHAKEE BELLAMY

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	171M00000X	Case Manager/Care Coordinator		OH

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	:	1770013922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKEE BELLAMY

Provider Business Mailing Address
First Line	:	701 JEFFERSON AVE STE 301
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-6957
Country	:	US
Telephone Number	:	419-214-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 JEFFERSON AVE STE 301
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-6957
Country	:	US
Telephone Number	:	419-214-5511
Fax Number	:

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

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	07/21/2022

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Directions to “ SHAKEE BELLAMY ” Practice Location

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