Provider Demographics
NPI:1740971936
Name:MCNELIS, SHANE ROBERT
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:ROBERT
Last Name:MCNELIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 LIBERTY AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2137
Mailing Address - Country:US
Mailing Address - Phone:412-996-0854
Mailing Address - Fax:
Practice Address - Street 1:2209 ARDMORE BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4851
Practice Address - Country:US
Practice Address - Phone:412-336-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor