Provider Demographics
NPI:1033008156
Name:BURGHARDT, SHELLY DAVEY
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:DAVEY
Last Name:BURGHARDT
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 1:10309 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-7313
Mailing Address - Country:US
Mailing Address - Phone:402-981-5023
Mailing Address - Fax:
Practice Address - Street 1:10309 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-7313
Practice Address - Country:US
Practice Address - Phone:402-981-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child