Individual
SHANICE MARY ANN MATOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
711 EXECUTIVE PL, FAYETTEVILLE, NC 28305-5193
(910) 615-3333
(910) 615-1623
Mailing address
350 ROYAL BIRKDALE DR, RAEFORD, NC 28376-8956
(917) 251-1167
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5017790
NC
Other
Enumeration date
03/10/2023
Last updated
05/01/2026
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