Healthcare Provider Details

I. General information

NPI: 1437068053
Provider Name (Legal Business Name): SHAYLAH REGINA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 NORTH ST APT 327C
NACOGDOCHES TX
75961-4019
US

IV. Provider business mailing address

1411 NORTH ST APT 327C
NACOGDOCHES TX
75961-4019
US

V. Phone/Fax

Practice location:
  • Phone: 832-612-7977
  • Fax:
Mailing address:
  • Phone: 832-612-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: