=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154981736
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YELENA SHABELNIK DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2019
-----------------------------------------------------
Last Update Date | 02/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 MADISON AVENUE, 6TH FLOOR
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-355-7118
-----------------------------------------------------
Fax | 856-325-5222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 LIPPINCOTT DRIVE, SUITE 410
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-355-7118
-----------------------------------------------------
Fax | 856-325-5222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | OS022556
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | OT019364
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 25IB12931000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------