1134914716 NPI number — MS. SHELLYANN DENISE THOMPSON LPN

Table of content: MS. SHELLYANN DENISE THOMPSON LPN (NPI 1134914716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134914716 NPI number — MS. SHELLYANN DENISE THOMPSON LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
SHELLYANN
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
SHELLYANN
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134914716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 WESTFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01109-3240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-519-1416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 WESTFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01109-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-519-1416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  LN92660 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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