Shelby Kailin Grandolfo

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

101 Bradford Village CT
Southern Pines, NC 28387-5451

Phone

(910) 684-8750

Fax

(910) 725-0536

NPI assigned

May 26, 2022

Last updated

May 26, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Greater Vision Counseling & Consulting Agency PLLC

  • Clinical Social Worker
  • Raeford, NC
  • NPI 1336661826
  NPD (past)

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

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653523200000",
    "number": "1770221020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 HARRIS AVE",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283763112",
            "telephone_number": "910-875-5590",
            "fax_number": "910-875-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BRADFORD VILLAGE CT",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283875451",
            "telephone_number": "910-684-8750",
            "fax_number": "910-725-0536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDOLFO",
        "first_name": "SHELBY",
        "middle_name": "KAILIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Goodrich, DDS
• Matthew Phillip Goodrich, DDS
• Dorian D Gorevin, PT, MSPT, OCS
• Lequita Gould
• Jennifer Gradolf, M.S.
• Jason Richard Graves, DMD
• Erin Cannon Gray, CPNP-PC
• Great Massage and Facial Spa
• Greater Image Healthcare Corp
• Melani Green, LPC

• Clinical Social Worker in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.