Provider Demographics
NPI:1538730163
Name:HEALD, SHILPA
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:HEALD
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 1:141 HANKS BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-0066
Mailing Address - Country:US
Mailing Address - Phone:734-717-5481
Mailing Address - Fax:
Practice Address - Street 1:653 BLUEFIELD RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9599
Practice Address - Country:US
Practice Address - Phone:734-717-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9553440163WP0200X
FL141595367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WP0200XNursing Service ProvidersRegistered NursePediatrics