Healthcare Provider Details

I. General information

NPI: 1427762780
Provider Name (Legal Business Name): SHELLY ALASTI AGNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 BENSON DR
RALEIGH NC
27609-7324
US

IV. Provider business mailing address

3729 BENSON DR
RALEIGH NC
27609-7324
US

V. Phone/Fax

Practice location:
  • Phone: 984-538-7504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5017491
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5017491
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5017491
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: