Provider Demographics
NPI:1740824440
Name:SHILLITO, SHELIEGH (RN)
Entity type:Individual
Prefix:MRS
First Name:SHELIEGH
Middle Name:
Last Name:SHILLITO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7542 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9649
Mailing Address - Country:US
Mailing Address - Phone:336-486-1852
Mailing Address - Fax:
Practice Address - Street 1:7542 BROOKFIELD DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9649
Practice Address - Country:US
Practice Address - Phone:336-486-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC169496163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29354682OtherPART B MEDICARE