Provider Demographics
NPI:1346307121
Name:SHELLER, SANDY (MA ATRBC)
Entity Type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:
Last Name:SHELLER
Suffix:
Gender:F
Credentials:MA ATRBC
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:SHELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA ATRBC
Mailing Address - Street 1:512 HOFFMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-527-5263
Mailing Address - Fax:610-527-2053
Practice Address - Street 1:715 N BROAD ST
Practice Address - Street 2:RED SHIELD FAMILY RESIDENCE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123
Practice Address - Country:US
Practice Address - Phone:215-787-2897
Practice Address - Fax:215-787-2964
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
PA05-190221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist