Provider Demographics
NPI:1285171991
Name:SHELLEY, SARA LYNN (MGC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:MGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N STREEPER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-1252
Mailing Address - Country:US
Mailing Address - Phone:760-517-8855
Mailing Address - Fax:760-517-8855
Practice Address - Street 1:135 N STREEPER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-1252
Practice Address - Country:US
Practice Address - Phone:309-368-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS