Provider Demographics
NPI:1982454278
Name:SHELLEY, TRACEE (CRPA)
Entity Type:Individual
Prefix:
First Name:TRACEE
Middle Name:
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:CRPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159-3310
Mailing Address - Country:US
Mailing Address - Phone:315-569-2480
Mailing Address - Fax:
Practice Address - Street 1:610 N STATE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1709
Practice Address - Country:US
Practice Address - Phone:315-748-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist