Provider Demographics
NPI:1881891091
Name:SCHELLHARDT, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SCHELLHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:LERRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2038
Mailing Address - Country:US
Mailing Address - Phone:609-261-7046
Mailing Address - Fax:609-914-6067
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-261-7046
Practice Address - Fax:609-914-6067
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00176400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical