MEDICARE: SHELLEE ANNE LUSUNG QUAGLIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F346631	NY
2	363L00000X	Nurse Practitioner	899877	NV
3	363L00000X	Nurse Practitioner	346631	NY

General Provider Information

NPI Number	:	1174124333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEE ANNE LUSUNG QUAGLIA

Provider Business Mailing Address
First Line	:	231 PINERY CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8700
Country	:	US
Telephone Number	:	905-979-3539
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 W CRAIG RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6563
Country	:	US
Telephone Number	:	702-233-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	04/14/2026

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