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Individual

SHANDA NICOLE FELTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
609 ATTAIN ST STE 101, FUQUAY VARINA, NC 27526-1984
(919) 567-0684
Mailing address
8 DURBIN PL, DURHAM, NC 27705-6127
(919) 423-7128

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0010-09102
NC
363A00000X
Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0010-09102
NORTH CAROLINA MEDICAL BOARD LICENSE
NC
Enumeration date
05/29/2019
Last updated
07/27/2022
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