Provider Demographics
NPI:1083747596
Name:PRUGER, SHELLI ELYSE (MA)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:ELYSE
Last Name:PRUGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:ELYSE
Other - Last Name:RABINOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3547
Mailing Address - Country:US
Mailing Address - Phone:916-317-4467
Mailing Address - Fax:
Practice Address - Street 1:5030 EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4650
Practice Address - Country:US
Practice Address - Phone:916-609-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator