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General NPI Number Information
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NPI Number | 1134439565
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Entity Type | Individual
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Provider Name | SHELLI LEORE FEDER MSN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 01/20/2013
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Provider Practice Location Address
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Address Line | 100 DOUBLE BEACH RD
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City | BRANFORD
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State | CT
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Zip | 06405-4909
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Country | US
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Telephone | 937-239-2801
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Fax |
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Provider Business Mailing Address
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Address Line | 19 WOODLAND ST APT 2
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City | NEW HAVEN
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State | CT
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Zip | 06511-3544
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Country | US
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Telephone | 937-239-2801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN1021360
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5274
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License Number State | CT
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