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Elizabeth Bernadette Shelley

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2015 Grand Concourse, Bronx, NY 10453-4303

PECOS Enrollment

This provider is enrolled in PECOS as ELIZABETH SHELLEY.

Based on the most recent information from CMS, provider Elizabeth Bernadette Shelley is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1073862207
Provider Type
Individual
Full Name
Shelley, Elizabeth Bernadette
Title
Ms.
Credential
MSN, FNP, RN

Gender
Female
Sole Proprietor
No
Enumeration Date
9/4/2012
Last Updated
3/16/2021

Contact Information

Practice Location

2015 Grand Concourse, Bronx, NY 10453-4303

(718) 299-7295

(718) 299-6797

Mailing Location

1434 Williamsbridge Rd Fl 2, Bronx, NY 10461-2507

(718) 618-0401

(347) 479-1303

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License F339329 New York
Code 163W00000X	Description Registered Nurse Nursing Service Providers	License 652493 New York

Provider Identifiers

ID	Description	Issuer
ID 04103251	Description Medicaid	Issuer Unlisted New York

Elizabeth Bernadette Shelley

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Ji, Minjung

Mathieu, Farah Eloise