Healthcare Provider Details

I. General information

NPI: 1912801077
Provider Name (Legal Business Name): SHELBY ARENA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HILLERY AVE
BUFFALO NY
14210-1905
US

IV. Provider business mailing address

22 HILLERY AVE
BUFFALO NY
14210-1905
US

V. Phone/Fax

Practice location:
  • Phone: 716-444-8046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: