Provider Demographics
NPI:1740641190
Name:BLOCHER, SHELLY LYN (CSFA)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LYN
Last Name:BLOCHER
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 S CREASY LN STE 120
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7433
Mailing Address - Country:US
Mailing Address - Phone:765-447-4165
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:1411 S CREASY LN STE 120
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7433
Practice Address - Country:US
Practice Address - Phone:765-447-4165
Practice Address - Fax:765-446-5317
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN128558246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant