Individual
SHELLEY ANN NICOLE PENNYCOOKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 E MOUNTAIN DR, WILKES BARRE, PA 18711-0027
(570) 808-7762
(570) 808-6128
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 808-7762
(570) 808-6128
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS024274
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0181943
—
NJ
01
—
P00766006
RR MEDICARE
NJ
Enumeration date
07/18/2007
Last updated
11/05/2025
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