Provider Demographics
NPI:1609688050
Name:STEWART, SHELBY ELLEN (NP-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELLEN
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 FALMOUTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2324
Mailing Address - Country:US
Mailing Address - Phone:774-552-3209
Mailing Address - Fax:
Practice Address - Street 1:1030 FALMOUTH RD STE 101
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2324
Practice Address - Country:US
Practice Address - Phone:774-552-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2363044363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care