Healthcare Provider Details

I. General information

NPI: 1487326427
Provider Name (Legal Business Name): SHALONDA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CLYBOURN
MILWAUKEE WI
53233
US

IV. Provider business mailing address

2130 W CLYBOURN ST
MILWAUKEE WI
53233-2510
US

V. Phone/Fax

Practice location:
  • Phone: 404-399-2105
  • Fax:
Mailing address:
  • Phone: 404-399-2105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: