Provider Demographics
NPI:1467049015
Name:DANZY, SHAWNDELE LANIK (NP)
Entity type:Individual
Prefix:MS
First Name:SHAWNDELE
Middle Name:LANIK
Last Name:DANZY
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8180 REGENT PKWY STE 115
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8417
Practice Address - Country:US
Practice Address - Phone:803-518-9079
Practice Address - Fax:704-626-6855
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24551363LP0808X
NC5017570363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1467049015Medicaid
MI1467049015Medicaid
SCNP7553Medicaid