Provider Demographics
NPI:1326196429
Name:ARCHER, SHELLY ANN M
Entity Type:Individual
Prefix:MRS
First Name:SHELLY ANN
Middle Name:M
Last Name:ARCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24018 146TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3287
Mailing Address - Country:US
Mailing Address - Phone:917-415-8052
Mailing Address - Fax:
Practice Address - Street 1:24018 146TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3287
Practice Address - Country:US
Practice Address - Phone:917-415-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor