Shelby Nicole Tacey, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

2902019648 Issued in MI

Practice address

2614 Center Ave
Bay City, MI 48708-6300

Phone

(989) 402-0510

NPI assigned

Mar 3, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Shelby Nicole Pedler Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1073213658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 CASS AVENUE RD",
            "city": "MUNGER",
            "state": "MI",
            "postal_code": "487479719",
            "telephone_number": "469-847-1866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2614 CENTER AVE",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487086300",
            "telephone_number": "989-402-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACEY",
        "first_name": "SHELBY",
        "middle_name": "NICOLE",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-03",
        "last_updated": "2023-03-03",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MI",
            "license": "2902019648",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "PEDLER",
            "middle_name": "NICOLE",
            "credential": "RDH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael James Szenay, PHARMD
• Kyle Szostek
• Breanna Leigh Tacey
• Julia Tacey
• Savannah Tacey
• Krista Nicole Tackebury
• Anne Mangalindan Tadeo, M.D.
• Ryan Talaski
• Gary Lee Tamez, DO
• Xiaoyin Tan

• Dental Hygienist in Bay City, MI
• Providers in Bay City, MI by specialty
• Dental Hygienist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.