Provider Demographics
NPI:1265231104
Name:HARRELL, SHANKEDRU CYREE (FNP)
Entity type:Individual
Prefix:
First Name:SHANKEDRU
Middle Name:CYREE
Last Name:HARRELL
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:SHANKEDRU
Other - Middle Name:CYREE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11602 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5599
Mailing Address - Country:US
Mailing Address - Phone:225-678-0540
Mailing Address - Fax:
Practice Address - Street 1:8911 N CAPITAL OF TEXAS HWY BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7247
Practice Address - Country:US
Practice Address - Phone:877-279-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily