Healthcare Provider Details

I. General information

NPI: 1467830687
Provider Name (Legal Business Name): SHELIA MARIA BLACK DNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELIA MARIA ANDERSON

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

3017 DALMATION DR
HOPE MILLS NC
28348-4008
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-0100
  • Fax: 910-678-0110
Mailing address:
  • Phone: 910-273-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5007628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: