Healthcare Provider Details

I. General information

NPI: 1831881168
Provider Name (Legal Business Name): SHELBY HUTCHERSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY LIPES

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 E 64TH ST
NEW YORK NY
10065-6704
US

IV. Provider business mailing address

327 E 64TH ST
NEW YORK NY
10065-6704
US

V. Phone/Fax

Practice location:
  • Phone: 646-608-1376
  • Fax:
Mailing address:
  • Phone: 646-608-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: