Provider Demographics
NPI:1427889823
Name:SHLAM, CHEYENNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:
Last Name:SHLAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-3511
Mailing Address - Country:US
Mailing Address - Phone:850-209-1870
Mailing Address - Fax:
Practice Address - Street 1:951 PRIM AVE
Practice Address - Street 2:
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-2505
Practice Address - Country:US
Practice Address - Phone:850-360-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11034435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily