Provider Demographics
NPI:1194346643
Name:EDWARDS, SHELLY MARIE
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:EDWARDS
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:PO BOX 667812
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-7812
Mailing Address - Country:US
Mailing Address - Phone:704-930-3125
Mailing Address - Fax:
Practice Address - Street 1:7800 WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-9148
Practice Address - Country:US
Practice Address - Phone:704-930-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty