Provider Demographics
NPI:1407967078
Name:MILLER, SHELLEY L (MS)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:1526 WALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4965
Mailing Address - Country:US
Mailing Address - Phone:716-895-6702
Mailing Address - Fax:
Practice Address - Street 1:1526 WALDEN AVE STE 400
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4985
Practice Address - Country:US
Practice Address - Phone:716-895-6700
Practice Address - Fax:716-895-0436
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY010990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030241501OtherUNIVERA
NY000506354003OtherCOMMUNITY BLUE