Healthcare Provider Details

I. General information

NPI: 1447032321
Provider Name (Legal Business Name): SHELLEY MAE CANDELARIA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S MAIN ST STE 1A
COTTONWOOD AZ
86326-4621
US

IV. Provider business mailing address

830 S MAIN ST STE 1A
COTTONWOOD AZ
86326-4621
US

V. Phone/Fax

Practice location:
  • Phone: 928-852-0472
  • Fax: 888-371-5734
Mailing address:
  • Phone: 928-852-0472
  • Fax: 888-371-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP331869
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN191434
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: