Dilleta Andree Shackelford, APRN

Primary specialty

Occupational Health Nurse PractitionerTaxonomy code 363LX0106X

License

RN080625 Issued in GA

Practice address

520 Griffin Ave
Valdosta, GA 31601-6331

Phone

(229) 249-6302

Fax

(229) 249-4009

NPI assigned

Jul 14, 2010

Sex

Female

Sole proprietor

Yes

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

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• SGMC Physician Network Inc

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1417597170
  Medicare reassignment NPD
• SGMC Affiliated Services LLC

  • Multi-Specialty Clinic/Center
  • Valdosta, GA
  • NPI 1114740362
  NPD
• Emergency Medicine South LLC

  • Emergency Medicine Physician
  • Valdosta, GA
  • NPI 1194785170
  NPD (past)

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

{
    "created_epoch": "1279065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279065600000",
    "number": "1811209208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 GRIFFIN AVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316016331",
            "telephone_number": "229-249-6302",
            "fax_number": "229-249-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 GRIFFIN AVE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316016331",
            "telephone_number": "229-249-6302",
            "fax_number": "229-249-4009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "DILLETA",
        "middle_name": "ANDREE",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-14",
        "last_updated": "2010-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "GA",
            "license": "RN080625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SGMC Affiliated Services LLC
• SGMC Affiliated Services LLC
• SGMC Physician Network Inc
• SGMP Southland LLC
• SGPC, PC
• Shaiva B Shah, PHARMD
• Vishal Shah
• Rabail Saeed Shaikh
• Umar Muhammad Shaikh
• Kadie Graham Shanders, LPC

• Occupational Health Nurse Practitioner in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Occupational Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.