MEDICARE: SHELLEY MAE CANDELARIA FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RNP331869	AZ
2	163WI0500X	Infusion Therapy Registered Nurse	RN191434	AZ

General Provider Information

NPI Number	:	1447032321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY MAE CANDELARIA FNP-BC

Provider Business Mailing Address
First Line	:	830 S MAIN ST STE 1A
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4621
Country	:	US
Telephone Number	:	928-852-0472
Fax Number	:	888-371-5734

Provider Business Practice Location Address
First Line	:	830 S MAIN ST STE 1A
Second Line	:
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-4621
Country	:	US
Telephone Number	:	928-852-0472
Fax Number	:	888-371-5734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	11/13/2025

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