Provider Demographics
NPI:1003859158
Name:CANNON, SHEILA NANNETTE (PMHNP/PMHCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:NANNETTE
Last Name:CANNON
Suffix:
Gender:F
Credentials:PMHNP/PMHCNS-BC
Other - Prefix:DR
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP, BC
Mailing Address - Street 1:100 GARDENGATE RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-9648
Mailing Address - Country:US
Mailing Address - Phone:757-478-4372
Mailing Address - Fax:
Practice Address - Street 1:100 W COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2419
Practice Address - Country:US
Practice Address - Phone:302-224-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2512129163W00000X
DEL1-0072437163W00000X
MA271878163WP0809X
NC5007307363LP0808X
DELE-0010201364SP0809X
NC319364SP0809X
DEL8-0010452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult