Individual
SHELBY L BLACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5520 PARK AVE STE WP-2300, TRUMBULL, CT 06611-3463
(203) 374-0310
Mailing address
60 METROPOLITAN PARK DR, RIVERSIDE, RI 02915-2150
(508) 463-7929
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4908
CT
Other
Enumeration date
06/29/2020
Last updated
10/01/2025
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