Provider Demographics
NPI:1831540483
Name:MORGAN, SHELLEY LINDA (LPN)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LINDA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4926
Mailing Address - Country:US
Mailing Address - Phone:678-200-5267
Mailing Address - Fax:347-374-3201
Practice Address - Street 1:1260 E 85TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4926
Practice Address - Country:US
Practice Address - Phone:678-200-5267
Practice Address - Fax:347-374-3201
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258330164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse