Provider Demographics
NPI:1194456590
Name:JUENEMAN, SHELBY TAYLOR (OD)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:TAYLOR
Last Name:JUENEMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BLUEMONT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5093
Mailing Address - Country:US
Mailing Address - Phone:785-539-8019
Mailing Address - Fax:
Practice Address - Street 1:2012 VANESTA PL STE 210
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-4101
Practice Address - Country:US
Practice Address - Phone:785-539-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist