Provider Demographics
NPI:1164225314
Name:BONELLO, SHELBY (BA)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:BONELLO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 SW SHARPSHINNED AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-1009
Mailing Address - Country:US
Mailing Address - Phone:352-422-5909
Mailing Address - Fax:
Practice Address - Street 1:1815 AMERICAN LEGION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3151
Practice Address - Country:US
Practice Address - Phone:208-590-1262
Practice Address - Fax:208-277-1342
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker