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General NPI Number Information
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NPI Number | 1750927018
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Entity Type | Individual
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Provider Name | JULIUS CHAMBERLAIN SHAYO NP-C
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Gender | Male
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 7161 REX RD
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-6457
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Country | US
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Telephone | 763-222-6096
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Fax |
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Provider Business Mailing Address
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Address Line | 7161 REX RD
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-6457
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Country | US
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Telephone | 763-222-6096
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 5012851
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN256265
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License Number State | NC
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