Provider Demographics
NPI:1770867046
Name:CAMPBELL-LEDGISTER, SHELLYANN ASHALEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHELLYANN
Middle Name:ASHALEE
Last Name:CAMPBELL-LEDGISTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2404
Mailing Address - Country:US
Mailing Address - Phone:646-938-1466
Mailing Address - Fax:
Practice Address - Street 1:500 LINDA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1313
Practice Address - Country:US
Practice Address - Phone:914-773-6787
Practice Address - Fax:914-773-7535
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator