Provider Demographics
NPI:1871018812
Name:ELONIS, SHELBY LYN
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYN
Last Name:ELONIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 QUAKER HILL RD APT A
Mailing Address - Street 2:
Mailing Address - City:UNITY
Mailing Address - State:ME
Mailing Address - Zip Code:04988-3713
Mailing Address - Country:US
Mailing Address - Phone:609-947-1625
Mailing Address - Fax:
Practice Address - Street 1:110 QUAKER HILL ROAD APT A
Practice Address - Street 2:
Practice Address - City:UNITY
Practice Address - State:ME
Practice Address - Zip Code:04988
Practice Address - Country:US
Practice Address - Phone:609-947-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health