Provider Demographics
NPI:1336984301
Name:NELSON, SHAMARYA MONET
Entity type:Individual
Prefix:
First Name:SHAMARYA
Middle Name:MONET
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 ASYLUM AVE APT B16
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1963
Mailing Address - Country:US
Mailing Address - Phone:959-529-7252
Mailing Address - Fax:
Practice Address - Street 1:887 ASYLUM AVE APT B16
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1963
Practice Address - Country:US
Practice Address - Phone:959-529-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician