Healthcare Provider Details

I. General information

NPI: 1700519261
Provider Name (Legal Business Name): SHAKEYLA COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 N SHARON AMITY RD STE 204
CHARLOTTE NC
28205-8992
US

IV. Provider business mailing address

8201 ARROWRIDGE BLVD STE 125
CHARLOTTE NC
28273-5873
US

V. Phone/Fax

Practice location:
  • Phone: 980-428-5069
  • Fax:
Mailing address:
  • Phone: 980-428-5069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number338708
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number338708
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number338708
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: