Provider Demographics
NPI:1689216749
Name:SIGNORELLI, SHELLI ALYSE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHELLI
Middle Name:ALYSE
Last Name:SIGNORELLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37436 ULTIMA PLAZA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3858
Mailing Address - Country:US
Mailing Address - Phone:337-303-8246
Mailing Address - Fax:
Practice Address - Street 1:37436 ULTIMA PLAZA BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-7076
Practice Address - Country:US
Practice Address - Phone:337-303-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12895111N00000X
LA1904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor