Provider Demographics
NPI:1225900152
Name:WALTERS, SHENELLE NALISA (LMSW)
Entity type:Individual
Prefix:
First Name:SHENELLE
Middle Name:NALISA
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 SHERIDAN AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1013
Mailing Address - Country:US
Mailing Address - Phone:347-840-3419
Mailing Address - Fax:
Practice Address - Street 1:1407 SHERIDAN AVE APT 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-1013
Practice Address - Country:US
Practice Address - Phone:347-840-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128573-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty