Provider Demographics
NPI:1053148676
Name:NELSON, SHANDEL (CALLAWAY(MAIDEN))
Entity type:Individual
Prefix:MS
First Name:SHANDEL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:CALLAWAY(MAIDEN)
Other - Prefix:PROF
Other - First Name:SHANDEL
Other - Middle Name:
Other - Last Name:CALLAWAY -NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CALLAWAY(MAIDEN)
Mailing Address - Street 1:4455 CONFEDERATE POINT RD APT 8C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5720
Mailing Address - Country:US
Mailing Address - Phone:585-635-4554
Mailing Address - Fax:
Practice Address - Street 1:8277 SAILMAKER LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3456
Practice Address - Country:US
Practice Address - Phone:585-635-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL107772376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide