Provider Demographics
NPI:1942350905
Name:WAKELEY, SHANNON ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELAINE
Last Name:WAKELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S 48TH ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1276
Mailing Address - Country:US
Mailing Address - Phone:402-405-0500
Mailing Address - Fax:402-404-0505
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:SUITE 510
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-405-0500
Practice Address - Fax:402-404-0505
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25490207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism