Healthcare Provider Details

I. General information

NPI: 1003827064
Provider Name (Legal Business Name): SHELLEY T. KRAFT LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W MILLBROOK RD SUITE 109
RALEIGH NC
27609-4389
US

IV. Provider business mailing address

115 MICHAEL WAY
CLAYTON NC
27520-5507
US

V. Phone/Fax

Practice location:
  • Phone: 919-845-9977
  • Fax: 919-845-9761
Mailing address:
  • Phone: 919-550-4880
  • Fax: 919-845-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1871
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: