MEDICARE: SHELLS HEALING HANDS, INC

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1497276455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLS HEALING HANDS, INC

Provider Business Mailing Address
First Line	:	21703 121ST AVE
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1935
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 AVENUE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4828
Country	:	US
Telephone Number	:	718-208-9810
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	MICHELLE WELLINGTON
Credential	:
Telephone Number	:	718-208-9810

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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