Provider Demographics
NPI:1689145260
Name:JOSEPH, SHELLY-ANN LENORE (CERT HAIR LOSS SPT)
Entity Type:Individual
Prefix:
First Name:SHELLY-ANN
Middle Name:LENORE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-5852
Mailing Address - Country:US
Mailing Address - Phone:347-542-2732
Mailing Address - Fax:
Practice Address - Street 1:375 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5635
Practice Address - Country:US
Practice Address - Phone:347-452-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management