Healthcare Provider Details

I. General information

NPI: 1740475896
Provider Name (Legal Business Name): SHELLY ANNE NIELSEN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PORTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 PORTRERO AVE
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5270
  • Fax:
Mailing address:
  • Phone: 415-206-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: