Nicole Shanley

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

2923288 Issued in GA

Practice address

175 Gwinnett Dr
Lawrenceville, GA 30046-8444

Phone

(678) 209-2394

NPI assigned

Jun 23, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1720719263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6264 SHOREVIEW CIR",
            "city": "FLOWERY BRANCH",
            "state": "GA",
            "postal_code": "305427604",
            "telephone_number": "515-343-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 GWINNETT DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468444",
            "telephone_number": "678-209-2394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANLEY",
        "first_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "2923288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vrundaben C Shah, PA
• Mazin Shaikhoun, MD
• Sidra Shakil, DO
• Stacy Marie Shamburger-Smith, PHARMD
• Sarah Cate Shanks, CCC-SLP
• Samuel Elliot Shapiro, D.O.
• Niraj Sharma, MD
• Shikha Sharma, DDS, MS
• Shiva Sharma, MD
• Veena Paras Sharma, PHARM D

• All providers in Lawrenceville, GA
• Addiction (Substance Use Disorder) Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.