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NPI Code Detail

MEDICARE: SHANDEE LASHEA ELLIS NP

MEDICARE:   SHANDEE LASHEA ELLIS  NP
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
1363LF0000XFamily Nurse Practitioner25462TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15021373OTHERNCSTATE LICENSE
225462OTHERTNSTATE LICENSE

General Provider Information

NPI Number : 1851945059
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANDEE LASHEA ELLIS NP
Provider Business Mailing Address
First Line : PO BOX 1258
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-1258
Country : US
Telephone Number : 931-253-1110
Fax Number :
Provider Business Practice Location Address
First Line : 756 COSBY HWY
Second Line :
City : NEWPORT
State : TN
Zip : 37821-3455
Country : US
Telephone Number : 423-237-6546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2019
Last Update Date : 06/19/2025

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