=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447032321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELLEY MAE CANDELARIA FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2023
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 S MAIN ST STE 1A
-----------------------------------------------------
City | COTTONWOOD
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86326-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-852-0472
-----------------------------------------------------
Fax | 888-371-5734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 S MAIN ST STE 1A
-----------------------------------------------------
City | COTTONWOOD
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86326-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-852-0472
-----------------------------------------------------
Fax | 888-371-5734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RNP331869
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Registered Nurse
-----------------------------------------------------
License Number | RN191434
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------