Provider Demographics
NPI:1538999610
Name:MCLEAN, SHELLY SHAMARA (APN)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:SHAMARA
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 KINGSLAND LN
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-1528
Mailing Address - Country:US
Mailing Address - Phone:646-504-9822
Mailing Address - Fax:
Practice Address - Street 1:1017 KINGSLAND LN
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-1528
Practice Address - Country:US
Practice Address - Phone:267-528-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY694554163WE0003X
NJ26NR22837400163WE0003X
NJ26NJ15138900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency