Individual
MS. SHELLEY JOAN CLANCY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, IBCLC,RLC
Contact information
Practice address
105 ROSELAND AVE, UNIT 901, CALDWELL, NJ 07006-5943
(201) 739-4058
Mailing address
105 ROSELAND AVE, UNIT 901, CALDWELL, NJ 07006-5943
(201) 739-4058
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
108-72946
NJ
163WL0100X
Lactation Consultant (Registered Nurse)
26NR06350900
NJ
163WL0100X
Lactation Consultant (Registered Nurse)
541810-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12455215
CAQH
NY
Enumeration date
10/26/2012
Last updated
10/26/2012
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