Provider Demographics
NPI:1891136636
Name:RAY, SHELLIE (NP)
Entity type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:RAY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:78 SUTTON AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-1813
Practice Address - Country:US
Practice Address - Phone:508-499-1760
Practice Address - Fax:508-499-1757
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1087141363LF0000X
MARN2380680363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily