Provider Demographics
NPI:1477826899
Name:SHELLEY, AUDREY ADELE
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ADELE
Last Name:SHELLEY
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 1:5227 FOG RUN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0515
Mailing Address - Country:US
Mailing Address - Phone:702-776-1132
Mailing Address - Fax:
Practice Address - Street 1:5227 FOG RUN CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0515
Practice Address - Country:US
Practice Address - Phone:702-776-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner