Provider Demographics
NPI:1104169861
Name:SHELLEY BERGER DOOLEY PC
Entity type:Organization
Organization Name:SHELLEY BERGER DOOLEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-686-0147
Mailing Address - Street 1:11000 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 163
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-6130
Mailing Address - Country:US
Mailing Address - Phone:602-686-0147
Mailing Address - Fax:
Practice Address - Street 1:11000 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 163
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6130
Practice Address - Country:US
Practice Address - Phone:602-686-0147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-034823251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP15508Medicare UPIN
AZ63199Medicare PIN