MEDICARE: MRS. AMY SHANEL ZELL

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1831431808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY SHANEL ZELL

Provider Business Mailing Address
First Line	:	618 MONTICELLO AVE
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22902-5736
Country	:	US
Telephone Number	:	434-295-6249
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 CHANCELLOR ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22903-2615
Country	:	US
Telephone Number	:	434-817-1050
Fax Number	:

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/18/2013

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