Provider Demographics
NPI:1891135729
Name:ADAMO, SHELLEY LYNN (MS ED)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:ADAMO
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 MARBLE SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4093
Mailing Address - Country:US
Mailing Address - Phone:718-356-0008
Mailing Address - Fax:718-356-6566
Practice Address - Street 1:80 WOODROW RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1313
Practice Address - Country:US
Practice Address - Phone:718-356-0008
Practice Address - Fax:718-356-6566
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY531279941174400000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No174400000XOther Service ProvidersSpecialist