Provider Demographics
NPI:1881831048
Name:SHELLY, JOEY P (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOEY
Middle Name:P
Last Name:SHELLY
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:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:HANNAWA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13647
Mailing Address - Country:US
Mailing Address - Phone:315-386-2325
Mailing Address - Fax:315-386-2781
Practice Address - Street 1:80 ST HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-2325
Practice Address - Fax:315-386-2781
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508500-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health