Healthcare Provider Details

I. General information

NPI: 1750285011
Provider Name (Legal Business Name): CHARELLE SHEARN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 FORREST AVE STE 203
DOVER DE
19904-3483
US

IV. Provider business mailing address

1125 FORREST AVE STE 203
DOVER DE
19904-3483
US

V. Phone/Fax

Practice location:
  • Phone: 302-346-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0013901
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: