Provider Demographics
NPI:1629478730
Name:SHADDEAU, RACHEAL ELLIOTT (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEAL
Middle Name:ELLIOTT
Last Name:SHADDEAU
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 POPLAR BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GRANDY
Mailing Address - State:NC
Mailing Address - Zip Code:27939-9775
Mailing Address - Country:US
Mailing Address - Phone:252-619-7980
Mailing Address - Fax:
Practice Address - Street 1:100 EMANCIPATION DRIVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132796363LF0000X
VA0024175611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily