Healthcare Provider Details

I. General information

NPI: 1578410890
Provider Name (Legal Business Name): SHELAHMER GABRIEL DELA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E LINDEN AVE
DUMONT NJ
07628-1916
US

IV. Provider business mailing address

220 E LINDEN AVE
DUMONT NJ
07628-1916
US

V. Phone/Fax

Practice location:
  • Phone: 551-998-1516
  • Fax:
Mailing address:
  • Phone: 551-998-1516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15658600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: