Provider Demographics
NPI:1972307544
Name:JACKSON, SHAYNA (BSN, RN, CMSRN, SANE)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:
Credentials:BSN, RN, CMSRN, SANE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 OBERLIN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-3130
Mailing Address - Country:US
Mailing Address - Phone:609-784-3810
Mailing Address - Fax:
Practice Address - Street 1:1012 OBERLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-3130
Practice Address - Country:US
Practice Address - Phone:919-863-9683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC277566163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse