Provider Demographics
NPI:1235994948
Name:KELKENBERG, SHELBY JOAN (FNP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JOAN
Last Name:KELKENBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6054
Mailing Address - Country:US
Mailing Address - Phone:716-539-0789
Mailing Address - Fax:
Practice Address - Street 1:8643 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6315
Practice Address - Country:US
Practice Address - Phone:716-539-0789
Practice Address - Fax:716-565-9038
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily