Healthcare Provider Details

I. General information

NPI: 1528542701
Provider Name (Legal Business Name): SHANELY MARMOLEJOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 GLENMORE AVE
BROOKLYN NY
11208-2310
US

IV. Provider business mailing address

802 GLENMORE AVE
BROOKLYN NY
11208-2310
US

V. Phone/Fax

Practice location:
  • Phone: 914-689-4246
  • Fax:
Mailing address:
  • Phone: 914-689-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: