Provider Demographics
NPI:1336537208
Name:GEORGE, SHELVA D (LPN)
Entity type:Individual
Prefix:
First Name:SHELVA
Middle Name:D
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13417 166TH PL
Mailing Address - Street 2:APT 7G
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3846
Mailing Address - Country:US
Mailing Address - Phone:347-741-5649
Mailing Address - Fax:
Practice Address - Street 1:13417 166TH PL
Practice Address - Street 2:APT 7G
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3846
Practice Address - Country:US
Practice Address - Phone:347-741-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 321136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse