Individual
SHELBY STATHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
230 S BROAD ST STE 402, PHILADELPHIA, PA 19102-4108
(215) 282-3004
Mailing address
781 N JUDSON ST, PHILADELPHIA, PA 19130-2507
(215) 282-3004
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW143043
PA
Other
Enumeration date
09/09/2025
Last updated
12/16/2025
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