Provider Demographics
NPI:1215570882
Name:SHELLY, ERICA FIONA (DNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:FIONA
Last Name:SHELLY
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 STARRY SKY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6547
Mailing Address - Country:US
Mailing Address - Phone:305-542-1261
Mailing Address - Fax:
Practice Address - Street 1:3000 ROGERS RD STE 200
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5745
Practice Address - Country:US
Practice Address - Phone:919-385-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC277095363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care