Healthcare Provider Details

I. General information

NPI: 1609732502
Provider Name (Legal Business Name): COURTNEY SHANAHAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SE CARY PKWY STE 100
CARY NC
27518-7413
US

IV. Provider business mailing address

267 SHADOW FALLS DR
WENDELL NC
27591-3309
US

V. Phone/Fax

Practice location:
  • Phone: 984-985-3095
  • Fax:
Mailing address:
  • Phone: 984-985-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023711
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: