Individual provider Active NPI

Shana Cortee' Waller Brye, FNP

  • Family Nurse Practitioner
  • Chapel Hill, NC
National Provider Identifier
1740514355
Registry record updated Jan 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
248530 Issued in NC
Practice address
6013 Farrington Rd Ste 301
Chapel Hill, NC 27517-8173
Phone
(984) 974-2645
NPI assigned
Sep 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 751834 CA
Family Nurse Practitioner 363LF0000X 248530 NC Primary

Addresses

Primary practice location

6013 Farrington Rd Ste 301
Chapel Hill, NC 27517-8173

Mailing address

6013 Farrington Rd Ste 301
Chapel Hill, NC 27517-8173
Phone (984) 974-2645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160927000930 NC Practitioner - Nurse Practitioner 2264729714 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
751834CAMDRegistered Nurse
248530NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Minuteclinic Diagnostic of North Carolina PC Family CurrentSince Jan 27, 2022 Accepting new patients

Locations

6840 Glenwood Ave
Raleigh, NC 27612
Phone (401) 770-4415

13304 Leesville Church Rd
Raleigh, NC 27617
Phone (919) 845-2489

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1740514355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6013 FARRINGTON RD STE 301",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275178173",
            "telephone_number": "984-974-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6013 FARRINGTON RD STE 301",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275178173",
            "telephone_number": "984-974-2645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYE",
        "first_name": "SHANA",
        "middle_name": "CORTEE' WALLER",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-29",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "751834",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "248530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chapel Hill, NC

Sources for this page

Verify at the official NPI Registry.