Provider Demographics
NPI:1487824462
Name:GLENN, SHELLEATHA DUNN
Entity Type:Individual
Prefix:
First Name:SHELLEATHA
Middle Name:DUNN
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 CHIPPENDALE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3781
Mailing Address - Country:US
Mailing Address - Phone:919-981-6317
Mailing Address - Fax:
Practice Address - Street 1:3029 CHIPPENDALE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3781
Practice Address - Country:US
Practice Address - Phone:919-981-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
ND251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health