Individual
SHELLY ANN FELICIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
329 E 149TH ST FL 4, BRONX, NY 10451-5626
(347) 928-2084
Mailing address
1020 CALHOUN AVE FL 1, BRONX, NY 10465-1911
(718) 769-2698
(718) 292-0208
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189119420
LICENSE
CT
Enumeration date
06/06/2018
Last updated
04/26/2019
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