Provider Demographics
NPI:1952985756
Name:SHEALEY-JOHNSON, NICHELE D
Entity Type:Individual
Prefix:
First Name:NICHELE
Middle Name:D
Last Name:SHEALEY-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-1139
Mailing Address - Country:US
Mailing Address - Phone:856-617-9309
Mailing Address - Fax:
Practice Address - Street 1:937 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-1139
Practice Address - Country:US
Practice Address - Phone:856-617-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA200023109376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide