Provider Demographics
NPI:1154092161
Name:SLOUGH, SHELETTA VALDEZ (NP)
Entity Type:Individual
Prefix:
First Name:SHELETTA
Middle Name:VALDEZ
Last Name:SLOUGH
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1670 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4004
Mailing Address - Country:US
Mailing Address - Phone:404-855-1195
Mailing Address - Fax:770-864-5177
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-855-1195
Practice Address - Fax:770-864-5177
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GANCO-000003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health