Provider Demographics
NPI:1891844890
Name:ROSHELLI, MARCELLA ELIZABETH (APNC)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:ELIZABETH
Last Name:ROSHELLI
Suffix:
Gender:F
Credentials:APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SURF CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-5201
Mailing Address - Country:US
Mailing Address - Phone:609-312-9269
Mailing Address - Fax:609-207-4102
Practice Address - Street 1:1301 ROUTE 72 W
Practice Address - Street 2:SUITE 250
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2483
Practice Address - Country:US
Practice Address - Phone:609-489-0888
Practice Address - Fax:609-207-4102
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR05675900163W00000X
NJ26NN05675900363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8092605Medicaid
NJ500009706OtherRAILROAD MEDICARE
NJ034726Medicare PIN
NJ500009706OtherRAILROAD MEDICARE