Provider Demographics
NPI:1073851416
Name:SHELAKER ENTERPRISES LLC
Entity type:Organization
Organization Name:SHELAKER ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SHELBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-408-1540
Mailing Address - Street 1:2856A LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8028
Mailing Address - Country:US
Mailing Address - Phone:270-408-1540
Mailing Address - Fax:270-408-1541
Practice Address - Street 1:2856A LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8028
Practice Address - Country:US
Practice Address - Phone:270-408-1540
Practice Address - Fax:270-408-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies