Provider Demographics
NPI:1134433709
Name:TAFT, SHELLY ANNE (LPN, CLC, IBCLC)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANNE
Last Name:TAFT
Suffix:
Gender:F
Credentials:LPN, CLC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3908
Mailing Address - Country:US
Mailing Address - Phone:508-245-5301
Mailing Address - Fax:
Practice Address - Street 1:165 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3908
Practice Address - Country:US
Practice Address - Phone:508-245-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula