Provider Demographics
NPI:1376833343
Name:GULELAT, SHETAYE
Entity Type:Individual
Prefix:MRS
First Name:SHETAYE
Middle Name:
Last Name:GULELAT
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 1:102 ORCHARD E
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1819
Mailing Address - Country:US
Mailing Address - Phone:917-952-9934
Mailing Address - Fax:
Practice Address - Street 1:667 ROUTE 739
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428
Practice Address - Country:US
Practice Address - Phone:570-775-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist