Provider Demographics
NPI:1104102425
Name:SHELLY, STEPHANIE M (MRP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:M
Last Name:SHELLY
Suffix:
Gender:F
Credentials:MRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 W UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3512
Mailing Address - Country:US
Mailing Address - Phone:484-903-8381
Mailing Address - Fax:
Practice Address - Street 1:618 4TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5575
Practice Address - Country:US
Practice Address - Phone:484-903-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist