Healthcare Provider Details

I. General information

NPI: 1063303196
Provider Name (Legal Business Name): SHANI ROSE DESHIELD FNP-C,FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4248 SUMMERLAND DRIVE
SHERWOOD PARK AB
T8H 0R2
CA

IV. Provider business mailing address

4248 SUMMERLAND DRIVE
SHERWOOD PARK AB
T8H 0R2
CA

V. Phone/Fax

Practice location:
  • Phone: 314-601-1144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70002118
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: