DR. SHENELLE ALYSE EDWARDS (NPI# 1932532553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932532553 |
| Entity Type | Individual |
| Full Name | DR. SHENELLE ALYSE EDWARDS |
| Credential | PHD |
| Practice Address |
4614 Country Club Rd Winston Salem NC 27104-3520 |
| Practice Telephone | 3367130700 |
| Mailing Telephone | 3367130700 |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2013-08-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103G00000X | Clinical Neuropsychologist | 4489 | NC | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
4498 | NC | Behavioral Health & Social Service Providers |
| Street Address |
4614 COUNTRY CLUB RD |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27104-3520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306823547 | William Y Rice IIi | Internal Medicine | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2005-12-29 |
| 1275162299 | Alexandria Jade Sutton | Student in an Organized Health Care Education/Training Program | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2020-04-02 |
| 1619504958 | Matthew Nigel Hugh Ellis | Student in an Organized Health Care Education/Training Program | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2020-03-26 |
| 1609416932 | Emily Stefano | Psychologist | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2020-01-15 |
| 1578113486 | Kayla Hansen | Dietitian, Registered | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2019-09-13 |
| 1356867162 | Michelle Faulkner | Dietitian, Registered | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2017-08-15 |
| 1245681097 | Jeanine Rivituso Kennedy | Dietitian, Registered | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2016-06-23 |
| 1467885244 | Megan H. Ragone | Social Worker | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2013-08-15 |
| 1669712840 | Terrika Dene Stewart Simmons | Nurse Practitioner | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2013-02-25 |
| 1144480716 | Stephanie Jane Myers | Internal Medicine | 4614 Country Club Rd, Winston Salem, NC 27104-3520 | 2008-06-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447807664 | Cameron Grant Ford | Psychologist | 614 Country Club Road, Winston-salem, NC 27104 | 2019-08-22 |
| 1104310374 | Novant Medical Group, Inc. | Internal Medicine | 4937 Old Country Club Rd, Winston Salem, NC 27104 | 2018-06-20 |
| 1982100509 | Dillon James Magalski | Student in an Organized Health Care Education/Training Program | Piedmont Plaza 1, 1920 West First Street, Wake Forest Baptist Medical Center, Winston-salem, NC 27104 | 2018-04-03 |
| 1891290144 | Breann M Poling | Student in an Organized Health Care Education/Training Program | Wake Forest Baptist Medical Center, Department Of, Family Medicine Piedmont Plaza I 1920 West First Street, Winston Salem, NC 27104 | 2018-03-28 |
| 1689178600 | Christopher Vasil | Student in an Organized Health Care Education/Training Program | Piedmont Plaza I, 1920 West First Street, Department of Family Medicine, Winston Salem, NC 27104 | 2018-03-23 |
| 1407379126 | April Lynn Lowe | Registered Nurse | 940 N Peace Haven Rd, Winstonsalem, NC 27104 | 2017-07-25 |
| 1164950804 | Donald Joyce | Student in an Organized Health Care Education/Training Program | 1920 West First St, Piedmont Plaza I Building, 3rd Floor, Winston-salem, NC 27104 | 2017-05-25 |
| 1255867289 | Benjamin Hansen | Pharmacist | 2150 Country Club Rd Ste 300, Winston Salem, NC 27104 | 2017-05-11 |
| 1770020976 | Jane Reed | Physical Medicine & Rehabilitation | 2627 E Greenbrier Road, Winston Salem, NC 27104 | 2017-01-25 |
| 1053728261 | Ashraf Alsaedi | Pharmacist | 1659 Stratford Rd Nw, Winston Salem, NC 27104 | 2014-07-20 |
| Find all providers in zip 27104 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922404839 | Marissa Griggs | Psychologist | 2905 Briarcliffe Rd, Winston Salem, NC 27106-3076 | 2014-11-05 |
| 1962640748 | David L Mount | Psychologist | 450 W Hanes Mill Rd, Suite Number 224, Winston Salem, NC 27105-9141 | 2009-02-02 |
| 1578734018 | Catherine Clodfelter Phd Pa | Psychologist | 3000 Bethesda Pl Ste 102, Winston Salem, NC 27103-3323 | 2008-03-12 |
| 1922277417 | Abc of Nc Child Development Center | Psychologist | 905 Friedberg Church Rd, Winston Salem, NC 27127-9803 | 2008-02-28 |
| 1871793497 | Myrna B. Williams | Psychologist | 1530 Martin St, Suite 203, Winston Salem, NC 27103-4936 | 2007-07-21 |
| 1205034477 | Dennis John Lynch | Psychologist | 823 W 5th St, Winston Salem, NC 27101-2544 | 2007-07-10 |
| 1114139862 | Linda Kimberly Dewindt | Psychologist | 1028 Franklin St, Winston Salem, NC 27101-5012 | 2007-05-04 |
| 1952526360 | David Christian Bullard | Psychologist | 2830 Maplewood Avenue, Suite A, Winston Salem, NC 27103-4114 | 2007-04-13 |
| 1619907987 | Linda Marie Nicolotti | Psychologist | 2910a Briarcliff Rd, Winston Salem, NC 27106-3077 | 2006-07-03 |
| 1114961406 | Michael Arnold Mccolloch | Psychologist | 1346 Ashley Sq, Winston Salem, NC 27103-2949 | 2006-06-16 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27104 |
Please comment or provide details below to improve the information on DR. SHENELLE ALYSE EDWARDS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.