Provider Demographics
NPI:1871833079
Name:EWERT, SHELLY J (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:J
Last Name:EWERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8996 WILKINSON RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9576
Mailing Address - Country:US
Mailing Address - Phone:585-815-3352
Mailing Address - Fax:
Practice Address - Street 1:8996 WILKINSON RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9576
Practice Address - Country:US
Practice Address - Phone:585-815-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620365172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker