Provider Demographics
NPI:1699169201
Name:BLUETT, SHELLEY (ND)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:BLUETT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 RAVENNA ST
Mailing Address - Street 2:SUITE B4
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236
Mailing Address - Country:US
Mailing Address - Phone:330-650-0400
Mailing Address - Fax:350-650-0449
Practice Address - Street 1:46 RAVENNA ST
Practice Address - Street 2:SUITE B4
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236
Practice Address - Country:US
Practice Address - Phone:330-650-0400
Practice Address - Fax:350-650-0449
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001201175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath