Provider Demographics
NPI:1861910481
Name:MOREIRA, SHALEY (NP)
Entity type:Individual
Prefix:
First Name:SHALEY
Middle Name:
Last Name:MOREIRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 N 14TH PL APT 3104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4346
Mailing Address - Country:US
Mailing Address - Phone:936-545-3703
Mailing Address - Fax:
Practice Address - Street 1:1634 S PRIEST DR STE 101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6499
Practice Address - Country:US
Practice Address - Phone:480-917-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMSL856836TX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily