Provider Demographics
NPI:1497177851
Name:TABLADILLO, SHELLYLIN
Entity Type:Individual
Prefix:
First Name:SHELLYLIN
Middle Name:
Last Name:TABLADILLO
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 1:1970 VILLA DE SOL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89156-7077
Mailing Address - Country:US
Mailing Address - Phone:702-596-0484
Mailing Address - Fax:
Practice Address - Street 1:1970 VILLA DE SOL ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-7077
Practice Address - Country:US
Practice Address - Phone:702-596-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-19
Last Update Date:2014-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor