Provider Demographics
NPI:1902324502
Name:WOODLEY, SHANELL LOVETTE (PMHNP)
Entity Type:Individual
Prefix:
First Name:SHANELL
Middle Name:LOVETTE
Last Name:WOODLEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SHANELL
Other - Middle Name:L
Other - Last Name:WOODLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:1620 EXTINE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3496
Mailing Address - Country:US
Mailing Address - Phone:919-744-9864
Mailing Address - Fax:
Practice Address - Street 1:1620 EXTINE LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3496
Practice Address - Country:US
Practice Address - Phone:919-744-9864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-03
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY534182163W00000X
NC192019163W00000X
NC5019636363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse