Provider Demographics
NPI:1265020358
Name:MCNEAL, SHELBY (NP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:OGDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4274 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6814
Mailing Address - Country:US
Mailing Address - Phone:229-242-1234
Mailing Address - Fax:
Practice Address - Street 1:4274 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-242-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268275363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily