Healthcare Provider Details

I. General information

NPI: 1861910481
Provider Name (Legal Business Name): SHALEY MOREIRA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2017
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 S PRIEST DR STE 101
TEMPE AZ
85281-6499
US

IV. Provider business mailing address

7810 N 14TH PL APT 3104
PHOENIX AZ
85020-4346
US

V. Phone/Fax

Practice location:
  • Phone: 480-917-6480
  • Fax:
Mailing address:
  • Phone: 936-545-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMSL856836TX
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: