Individual
SHINY SAMUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
550 NEW WAVERLY PL STE 105, CARY, NC 27518-7412
(919) 233-2022
Mailing address
101 DEER ISLE CT, CARY, NC 27519-6465
(919) 946-4059
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
5010430
NC
Other
Enumeration date
04/02/2018
Last updated
04/02/2018
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