Provider Demographics
NPI:1255441150
Name:MERCADAL, SHELLEY (RNP)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:
Last Name:MERCADAL
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:D
Other - Last Name:RAYNE-WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:625 HILBY AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5720
Practice Address - Country:US
Practice Address - Phone:831-394-1691
Practice Address - Fax:831-394-1870
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 3094363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P31484Medicare UPIN