Provider Demographics
NPI:1821525940
Name:SHELKIN, ALICIA (CRNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SHELKIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 FERNWAY DR
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-8186
Mailing Address - Country:US
Mailing Address - Phone:570-856-8387
Mailing Address - Fax:
Practice Address - Street 1:1154A W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1323
Practice Address - Country:US
Practice Address - Phone:570-424-1235
Practice Address - Fax:570-424-1259
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017432363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health