Healthcare Provider Details

I. General information

NPI: 1194337287
Provider Name (Legal Business Name): LAUREN HICKS SHELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MILESTONE RD
DANBURY CT
06810-5114
US

IV. Provider business mailing address

98 WELLS HILL RD
EASTON CT
06612-1525
US

V. Phone/Fax

Practice location:
  • Phone: 203-702-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9112
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: