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General NPI Number Information
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NPI Number | 1639795859
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Entity Type | Individual
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Provider Name | SHATARRA TAVONIA SALLEY APRN, FNP-C, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 13455 E WADE HAMPTON BLVD STE 17
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City | GREER
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State | SC
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Zip | 29651-6276
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Country | US
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Telephone | 864-551-2384
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Fax | 864-499-2697
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Provider Business Mailing Address
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Address Line | PO BOX 749306
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City | ATLANTA
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State | GA
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Zip | 30374-9306
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Country | US
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Telephone | 864-968-9144
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Fax | 864-968-9244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 24906
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 24906
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License Number State | SC
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