Provider Demographics
NPI:1720549124
Name:SHELTON, SHARDAI NICHOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARDAI
Middle Name:NICHOLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 ALA WAI BLVD APT 1006
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1521
Mailing Address - Country:US
Mailing Address - Phone:217-322-8563
Mailing Address - Fax:
Practice Address - Street 1:1717 ALA WAI BLVD APT 1006
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1521
Practice Address - Country:US
Practice Address - Phone:217-322-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2667363LF0000X
IL209.015712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty