Provider Demographics
NPI:1396634663
Name:FORNES, SHAUNACI SIMONE CAGE (RN,RNC-NIC, CLC)
Entity type:Individual
Prefix:MRS
First Name:SHAUNACI
Middle Name:SIMONE CAGE
Last Name:FORNES
Suffix:
Gender:F
Credentials:RN,RNC-NIC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NEW CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1848
Mailing Address - Country:US
Mailing Address - Phone:919-604-2653
Mailing Address - Fax:
Practice Address - Street 1:1001 NEW CREEK WAY
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-1848
Practice Address - Country:US
Practice Address - Phone:919-604-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC283568163W00000X, 163WL0100X, 163WN0002X
CA95191813163W00000X, 163WL0100X
MN2537523163W00000X
MN283568163WL0100X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No174N00000XOther Service ProvidersLactation Consultant, Non-RN