Provider Demographics
NPI:1255116752
Name:PINCENTI, SHELISSIA MARIE
Entity type:Individual
Prefix:
First Name:SHELISSIA
Middle Name:MARIE
Last Name:PINCENTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELISSIA
Other - Middle Name:
Other - Last Name:PINCENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CORNFORD
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-0880
Mailing Address - Country:US
Mailing Address - Phone:208-202-9775
Mailing Address - Fax:
Practice Address - Street 1:1059 NW MADRAS HWY
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1416
Practice Address - Country:US
Practice Address - Phone:541-233-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator