Provider Demographics
NPI:1821295312
Name:LEVULIS, SHELLY ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:ANN
Last Name:LEVULIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:PA
Mailing Address - Zip Code:18651-1744
Mailing Address - Country:US
Mailing Address - Phone:570-287-1955
Mailing Address - Fax:570-287-1995
Practice Address - Street 1:75 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:PA
Practice Address - Zip Code:18651-1744
Practice Address - Country:US
Practice Address - Phone:570-287-1955
Practice Address - Fax:570-287-1995
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005978213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist