1780943423 NPI number — SHELLI DRY PEDIATRIC THERAPY, PLLC

Table of content: MS. REBECCA LYNN BAUDINO LMHC (NPI 1730295882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780943423 NPI number — SHELLI DRY PEDIATRIC THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELLI DRY PEDIATRIC THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780943423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 LIZAS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40067-5601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-797-4536
Provider Business Mailing Address Fax Number:
502-384-8386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 LIZA'S CIR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIMPSONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-797-4536
Provider Business Practice Location Address Fax Number:
502-384-8386
Provider Enumeration Date:
05/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DRY
Authorized Official First Name:
SHELLI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-797-4536

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  R2278 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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