Healthcare Provider Details

I. General information

NPI: 1780510248
Provider Name (Legal Business Name): SHELBY LAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38A OLD SPARROWBUSH RD
LATHAM NY
12110-2927
US

IV. Provider business mailing address

30 CIRCULAR ST APT 2B
SARATOGA SPRINGS NY
12866-4200
US

V. Phone/Fax

Practice location:
  • Phone: 518-690-0700
  • Fax:
Mailing address:
  • Phone: 518-423-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360138-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: