Healthcare Provider Details

I. General information

NPI: 1124964721
Provider Name (Legal Business Name): LINDSEY SHELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CENTRE DR STE 1
ORCHARD PARK NY
14127-4100
US

IV. Provider business mailing address

5 COLONIAL DR APT 8
SPRINGVILLE NY
14141-1374
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-2294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: