Provider Demographics
NPI:1467049015
Name:DANZY, SHAWNDELE LANIK (APRN)
Entity Type:Individual
Prefix:MS
First Name:SHAWNDELE
Middle Name:LANIK
Last Name:DANZY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TIE LN
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067-8746
Mailing Address - Country:US
Mailing Address - Phone:803-518-9079
Mailing Address - Fax:
Practice Address - Street 1:6047 TYVOLA GLEN CIR STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6431
Practice Address - Country:US
Practice Address - Phone:803-518-9079
Practice Address - Fax:704-626-6855
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24551363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP7553Medicaid