Provider Demographics
NPI:1730480914
Name:SHELLY A LEVULIS
Entity Type:Organization
Organization Name:SHELLY A LEVULIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVULIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-287-1955
Mailing Address - Street 1:33 GATEWAY SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4424
Mailing Address - Country:US
Mailing Address - Phone:570-287-1955
Mailing Address - Fax:570-287-1995
Practice Address - Street 1:33 GATEWAY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-4424
Practice Address - Country:US
Practice Address - Phone:570-287-1955
Practice Address - Fax:570-287-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005978213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty