Provider Demographics
NPI:1528764412
Name:OLUWALANA, SHELBY NICOLE
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:NICOLE
Last Name:OLUWALANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:NICOLE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2875 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3414
Mailing Address - Country:US
Mailing Address - Phone:559-312-0888
Mailing Address - Fax:
Practice Address - Street 1:3798 WALKER AVENUE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-0001
Practice Address - Country:US
Practice Address - Phone:901-678-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health