Provider Demographics
NPI:1598042103
Name:PHELPS, SHALETHA (RN)
Entity Type:Individual
Prefix:
First Name:SHALETHA
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DETROIT AVE
Mailing Address - Street 2:APT 219
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2445
Mailing Address - Country:US
Mailing Address - Phone:216-526-7327
Mailing Address - Fax:
Practice Address - Street 1:1500 DETROIT AVE
Practice Address - Street 2:APT 219
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2445
Practice Address - Country:US
Practice Address - Phone:216-526-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.409179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse