Healthcare Provider Details

I. General information

NPI: 1598108920
Provider Name (Legal Business Name): SHELLY LYN SCOTT ADKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 N BROAD ST
PHILADELPHIA PA
19140-4107
US

IV. Provider business mailing address

404 FRANKFORD AVE
BLACKWOOD NJ
08012-4534
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 856-209-9468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number26NO09967400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN334754L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: