MEDICARE: SHAUN KELLI CHALFANT NP

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	71010132A	IN
2	163WC0200X	Critical Care Medicine Registered Nurse	28211669A	IN

General Provider Information

NPI Number	:	1558980565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN KELLI CHALFANT NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 FERRY ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-3021
Country	:	US
Telephone Number	:	765-449-1555
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	07/13/2022

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