Provider Demographics
NPI:1225646805
Name:AMEDURI, SHELLEY ELIZABETH (APRN, NP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ELIZABETH
Last Name:AMEDURI
Suffix:
Gender:F
Credentials:APRN, NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 DELUGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6481
Mailing Address - Country:US
Mailing Address - Phone:808-895-9080
Mailing Address - Fax:
Practice Address - Street 1:3943 DELUGE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6481
Practice Address - Country:US
Practice Address - Phone:808-895-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV832591363LF0000X, 207Q00000X, 363LP0808X
CA95017026363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine