Provider Demographics
NPI:1275634404
Name:SHELHAV, LAURA (DOM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SHELHAV
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 INCA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4929
Mailing Address - Country:US
Mailing Address - Phone:505-604-4372
Mailing Address - Fax:505-323-0033
Practice Address - Street 1:1719 GIRARD BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1718
Practice Address - Country:US
Practice Address - Phone:505-604-4372
Practice Address - Fax:505-323-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM642171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist