Provider Demographics
NPI:1104234012
Name:STRATFORD, SHELLEY LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:STRATFORD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:LYNN
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 DIVISADERO ST
Mailing Address - Street 2:FL 4
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-3010
Mailing Address - Country:US
Mailing Address - Phone:661-904-5497
Mailing Address - Fax:
Practice Address - Street 1:418 CURIE BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4217
Practice Address - Country:US
Practice Address - Phone:215-898-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN656377163W00000X
CA95002302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse