Provider Demographics
NPI:1609126127
Name:ELLIOTT, SHELETTA DANIELLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHELETTA
Middle Name:DANIELLE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A9 BROGAN MNR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1018
Mailing Address - Country:US
Mailing Address - Phone:315-277-6074
Mailing Address - Fax:
Practice Address - Street 1:A9 BROGAN MNR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1018
Practice Address - Country:US
Practice Address - Phone:315-277-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311385164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse