Provider Demographics
NPI:1790490225
Name:STAPLETON, SHELBY (BA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FENNER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1833
Mailing Address - Country:US
Mailing Address - Phone:757-808-4261
Mailing Address - Fax:
Practice Address - Street 1:34 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-2610
Practice Address - Country:US
Practice Address - Phone:774-206-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health