Healthcare Provider Details

I. General information

NPI: 1174998686
Provider Name (Legal Business Name): SHALOM CHERIAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BEAVER CREEK COMMONS DR
APEX NC
27502-3922
US

IV. Provider business mailing address

1952 WEAVER FOREST WAY
MORRISVILLE NC
27560-6693
US

V. Phone/Fax

Practice location:
  • Phone: 919-372-1405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008235
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008235
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: