Healthcare Provider Details

I. General information

NPI: 1427889823
Provider Name (Legal Business Name): CHEYENNE SHLAM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MAIN ST STE 21
DOTHAN AL
36305-1058
US

IV. Provider business mailing address

4300 W MAIN ST
DOTHAN AL
36305-1054
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-7900
  • Fax:
Mailing address:
  • Phone: 850-209-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-002866
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: