Provider Demographics
NPI:1679296040
Name:SHELBORNE, NAKEYA S
Entity type:Individual
Prefix:
First Name:NAKEYA
Middle Name:S
Last Name:SHELBORNE
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 1:158 PAPER MILL RD APT 5204
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5347
Mailing Address - Country:US
Mailing Address - Phone:678-832-5023
Mailing Address - Fax:
Practice Address - Street 1:158 PAPER MILL RD APT 5204
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5347
Practice Address - Country:US
Practice Address - Phone:678-832-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA376J00000X
376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker