Provider Demographics
NPI:1912279761
Name:BAILEY, SHANA DAWN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:DAWN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3801 COMPUTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6506
Mailing Address - Country:US
Mailing Address - Phone:919-782-5273
Mailing Address - Fax:919-781-8853
Practice Address - Street 1:3801 COMPUTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6506
Practice Address - Country:US
Practice Address - Phone:919-782-5273
Practice Address - Fax:919-781-8853
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC218962363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics