Provider Demographics
NPI:1902042914
Name:HAMILTON, SHELLEY SECOOLISH (AUD)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:SECOOLISH
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:DEE
Other - Last Name:SECOOLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:223 MONMOUTH RD
Mailing Address - Street 2:STE 1A
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1024
Mailing Address - Country:US
Mailing Address - Phone:732-229-4089
Mailing Address - Fax:732-229-4089
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLENHURST
Practice Address - State:NJ
Practice Address - Zip Code:07711-1040
Practice Address - Country:US
Practice Address - Phone:732-517-1200
Practice Address - Fax:732-663-0179
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA00424231H00000X
NJMG00855237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter