Provider Demographics
NPI:1023593894
Name:JENNINGS, SHELBY RAE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RAE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 ARROWROOT WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7973
Mailing Address - Country:US
Mailing Address - Phone:765-541-0097
Mailing Address - Fax:
Practice Address - Street 1:3033 ARROWROOT WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-7973
Practice Address - Country:US
Practice Address - Phone:765-541-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist