MEDICARE: SHALEEA MASON 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	163W00000X	Registered Nurse	28201757A	IN
2	363L00000X	Nurse Practitioner	28201757A	IN

General Provider Information

NPI Number	:	1891174447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALEEA MASON NP

Provider Business Mailing Address
First Line	:	9636 PIPER LAKE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-6830
Country	:	US
Telephone Number	:	317-640-5072
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 W US 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9770
Country	:	US
Telephone Number	:	317-861-4838
Fax Number	:

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

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	04/11/2025

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