Provider Demographics
NPI:1740275072
Name:PHELAN, SHAWN P (DO)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:P
Last Name:PHELAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:STE. E
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7366
Mailing Address - Country:US
Mailing Address - Phone:919-562-0302
Mailing Address - Fax:919-569-9560
Practice Address - Street 1:851 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:STE. E
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7366
Practice Address - Country:US
Practice Address - Phone:919-562-0302
Practice Address - Fax:919-569-9560
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2449645AMedicare PIN