Provider Demographics
NPI:1740524909
Name:CLAVIS, SHELLY (RN, MSN, NP-C, FNP)
Entity type:Individual
Prefix:MISS
First Name:SHELLY
Middle Name:
Last Name:CLAVIS
Suffix:
Gender:
Credentials:RN, MSN, NP-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2715
Mailing Address - Country:US
Mailing Address - Phone:973-760-0707
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00402800363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0341151Medicaid