Healthcare Provider Details

I. General information

NPI: 1407769409
Provider Name (Legal Business Name): SHAQUANDRA SHANTEZ DAWSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3613 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

IV. Provider business mailing address

3613 CAPE CENTER DR
FAYETTEVILLE NC
28304-4457
US

V. Phone/Fax

Practice location:
  • Phone: 910-354-1720
  • Fax:
Mailing address:
  • Phone: 910-354-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025541
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: