Healthcare Provider Details

I. General information

NPI: 1154827046
Provider Name (Legal Business Name): SHANNON M BEELEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUKE RHEUMATOLOGY CLINIC 40 MEDICINE CIRCLE CINIC 1J
DURHAM NC
27710
US

IV. Provider business mailing address

1706 WALLACE ST
DURHAM NC
27707-1552
US

V. Phone/Fax

Practice location:
  • Phone: 919-613-2243
  • Fax:
Mailing address:
  • Phone: 203-927-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number303305
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number123052
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011364
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: