Provider Demographics
NPI:1962641829
Name:ALLI, SHELLY RESHMA
Entity Type:Individual
Prefix:MISS
First Name:SHELLY
Middle Name:RESHMA
Last Name:ALLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15015 115TH ST
Mailing Address - Street 2:WAKEFIELD
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-3920
Mailing Address - Country:US
Mailing Address - Phone:646-932-1511
Mailing Address - Fax:
Practice Address - Street 1:15015 115TH ST
Practice Address - Street 2:WAKEFIELD
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-3920
Practice Address - Country:US
Practice Address - Phone:646-932-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist