Healthcare Provider Details

I. General information

NPI: 1508770082
Provider Name (Legal Business Name): SHELLEY MARIE DUNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9865 E 116TH ST STE 300
FISHERS IN
46037-9238
US

IV. Provider business mailing address

9865 E 116TH ST STE 300
FISHERS IN
46037-9238
US

V. Phone/Fax

Practice location:
  • Phone: 765-234-6463
  • Fax: 855-631-0690
Mailing address:
  • Phone: 765-234-6463
  • Fax: 855-631-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28218324A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number28218324A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28218324A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: