Provider Demographics
NPI:1962078089
Name:WARREN, SHIALLA DENEEN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHIALLA
Middle Name:DENEEN
Last Name:WARREN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:12461 VETERANS MEMORIAL HWY STE 805
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2025
Mailing Address - Country:US
Mailing Address - Phone:404-595-8722
Mailing Address - Fax:678-737-1432
Practice Address - Street 1:12461 VETERANS MEMORIAL HWY STE 805
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2025
Practice Address - Country:US
Practice Address - Phone:404-595-8722
Practice Address - Fax:678-737-1432
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-30
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN257957363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health