Provider Demographics
NPI:1043736523
Name:MARCELLUS, SHEILA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:MARCELLUS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1839
Mailing Address - Country:US
Mailing Address - Phone:508-580-4611
Mailing Address - Fax:508-580-4404
Practice Address - Street 1:22 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1839
Practice Address - Country:US
Practice Address - Phone:508-580-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237861363LP0808X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst