MEDICARE: KATE ELIZABETH SHELLHAMMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	658388	NY

General Provider Information

NPI Number	:	1265918270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE ELIZABETH SHELLHAMMER

Provider Business Mailing Address
First Line	:	557 BROADWAY APT 15C
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-5608
Country	:	US
Telephone Number	:	845-389-7819
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 BROADWAY APT 15C
Second Line	:
City	:	PORT EWEN
State	:	NY
Zip	:	12466-5608
Country	:	US
Telephone Number	:	845-389-7819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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