Provider Demographics
NPI:1457148215
Name:SHELLY CLAVIS, APN, DNP, LLC
Entity type:Organization
Organization Name:SHELLY CLAVIS, APN, DNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:EILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PASKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-500-6992
Mailing Address - Street 1:337 ACADEMY TER
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5601
Mailing Address - Country:US
Mailing Address - Phone:201-500-6992
Mailing Address - Fax:833-605-4359
Practice Address - Street 1:337 ACADEMY TER
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5601
Practice Address - Country:US
Practice Address - Phone:201-500-6992
Practice Address - Fax:833-605-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0341151Medicaid