Provider Demographics
NPI:1770803918
Name:REELAND, SHELLEY (RN, LMT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:REELAND
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:REELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1388 RT 96 NORTH
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165
Mailing Address - Country:US
Mailing Address - Phone:315-539-1357
Mailing Address - Fax:
Practice Address - Street 1:1388 RT 96 N
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165
Practice Address - Country:US
Practice Address - Phone:315-539-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0154041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0154041OtherLMT LICENSE