Provider Demographics
NPI:1003695479
Name:GREAVES, SHELLY (RN)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:
Last Name:GREAVES
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 1:17 RICHBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3915
Mailing Address - Country:US
Mailing Address - Phone:516-508-1477
Mailing Address - Fax:
Practice Address - Street 1:17 RICHBOURNE LN
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3915
Practice Address - Country:US
Practice Address - Phone:516-508-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY747955163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice