Provider Demographics
NPI:1023361995
Name:PASQUARELLI, SHELLY (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:
Last Name:PASQUARELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 WHITESBORO ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13495-1313
Mailing Address - Country:US
Mailing Address - Phone:315-266-3424
Mailing Address - Fax:315-735-3358
Practice Address - Street 1:9479 MAYNARD DRIVE
Practice Address - Street 2:
Practice Address - City:MARCY
Practice Address - State:NY
Practice Address - Zip Code:13403
Practice Address - Country:US
Practice Address - Phone:315-266-3424
Practice Address - Fax:315-735-3358
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399180-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool