MEDICARE: MS. SHELLEY HOLDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	076785-01	NY

General Provider Information

NPI Number	:	1215793849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY HOLDER

Provider Business Mailing Address
First Line	:	1655 FLATBUSH AVE APT B1804
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-6911
Country	:	US
Telephone Number	:	347-267-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 ELTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-5418
Country	:	US
Telephone Number	:	347-267-2215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2024
Last Update Date	:	02/21/2024

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