Provider Demographics
NPI:1598239881
Name:ABRAMSON, SHELBY (FNP, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:ABRAMSON
Suffix:
Gender:F
Credentials:FNP, IBCLC
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:POLAKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2440 FENTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3516
Mailing Address - Country:US
Mailing Address - Phone:619-656-3040
Mailing Address - Fax:619-656-3045
Practice Address - Street 1:2440 FENTON ST STE 100
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3516
Practice Address - Country:US
Practice Address - Phone:619-656-3040
Practice Address - Fax:619-656-3045
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN170813163WL0100X
AZ229089363LF0000X
CA95021487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229089OtherCERTIFIED NURSE PRACTITIONER
AZ229089Medicaid