NPIMap

Individual provider Active NPI

Shellalyn Ito-Lucas

  • Acute Care Nurse Practitioner
  • Durham, NC
National Provider Identifier
1295214013
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
5018236 Issued in NC
Practice address
3643 N Roxboro St
Durham, NC 27704-2702
Phone
(919) 470-4000
NPI assigned
Aug 13, 2018
Last updated
Aug 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 26NR11878000 NJ
Acute Care Nurse Practitioner 363LA2100X 5018236 NC Primary

Addresses

Primary practice location

3643 N Roxboro St
Durham, NC 27704-2702

Mailing address

1000 Lakeside Terrace CT Apt 112
Wake Forest, NC 27587-3221
Phone (973) 452-1892

Other practice location 1

2310 Erwin Rd
Durham, NC 27710-2702
Phone (919) 470-4000

Other identifiers 1

IdentifierTypeStateIssuer
1295214013OtherNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180914000216 NJ Practitioner - Nurse Practitioner 1557611423 Reassigns benefits to 1 organization
I20230919003924 NC Practitioner - Nurse Practitioner 1557611423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke University Health System, IncGroup PAC ID 2567372345, 1,083 clinicians

Practice addresses (Care Compare)

3643 N Roxboro Rd
Durham, NC 27704-2702
Phone (919) 470-8490

3643 N Roxboro St
Durham, NC 27704-2702
Phone (919) 470-5356

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5018236NCMDAcute Care Nurse Practitioner
26NR11878000NJMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Health System, Inc. CurrentSince Jul 3, 2023 Accepting new patients
Internal Medicine of Morris County LLC CurrentSince Mar 1, 2023 Accepting new patients
Duke University Health System, Inc. CurrentSince Jul 3, 2023 Accepting new patients
Alice Tzeng MD LLC CurrentSince May 11, 2020 Accepting new patients
Vital Medical Forces of Dover PC Past Accepting new patients

Locations

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

40 Watchung Way
Berkeley Hts, NJ 07922
Phone (908) 771-5700

25 Pocono Rd
Denville, NJ 07834
Phone (273) 625-6000

400 W Blackwell St
Dover, NJ 07801
Phone (973) 537-3818

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1295214013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 LAKESIDE TERRACE CT APT 112",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275873221",
            "telephone_number": "973-452-1892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3643 N ROXBORO ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277042702",
            "telephone_number": "919-470-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2310 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277102702",
            "country_code": "US",
            "telephone_number": "919-470-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ITO-LUCAS",
        "first_name": "SHELLALYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NJ",
            "license": "26NR11878000",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NC",
            "license": "5018236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1295214013",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.