Provider Demographics
NPI:1841762762
Name:FAUST, SHAWN (DNP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:FAUST
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 BREVARD RD UNIT 216
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-0026
Mailing Address - Country:US
Mailing Address - Phone:520-909-3288
Mailing Address - Fax:
Practice Address - Street 1:3740 BREVARD RD UNIT 216
Practice Address - Street 2:
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742-0026
Practice Address - Country:US
Practice Address - Phone:336-515-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR49981363LP0808X
AZRN182078163W00000X
NY403915363LP0808X
IN71015544A363LP0808X
AK181097363LP0808X
AZ224121363LP0808X
AR230693363LP0808X
MECNP211665363LP0808X
OH0037083363LP0808X
NC5014284363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse