Provider Demographics
NPI:1861274771
Name:MAPLES, SHELLA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:SHELLA
Middle Name:
Last Name:MAPLES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHELLA
Other - Middle Name:AMPARO
Other - Last Name:FONTILLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3488 AGATE DR APT 6
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-1030
Mailing Address - Country:US
Mailing Address - Phone:408-386-4996
Mailing Address - Fax:
Practice Address - Street 1:3488 AGATE DR APT 6
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-1030
Practice Address - Country:US
Practice Address - Phone:408-386-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2022095492363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care