MEDICARE: SHAVONE 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	1744P3200X	Prosthetics Case Management
2	1744P3200X	Prosthetics Case Management		GA

General Provider Information

NPI Number	:	1982365979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAVONE BELLAMY

Provider Business Mailing Address
First Line	:	2164 US HIGHWAY 84
Second Line	:
City	:	BLACKSHEAR
State	:	GA
Zip	:	31516-1160
Country	:	US
Telephone Number	:	254-458-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 KINGSLEY AVE STE 210
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5685
Country	:	US
Telephone Number	:	912-722-3281
Fax Number	:

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

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	04/10/2023

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Directions to “ SHAVONE BELLAMY ” Practice Location

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