Provider Demographics
NPI:1467756346
Name:HOLLOWAY, SHELLEY L (MED)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:L
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 MYSTIC ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3441
Mailing Address - Country:US
Mailing Address - Phone:914-346-2692
Mailing Address - Fax:
Practice Address - Street 1:151 MYSTIC ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:914-346-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health