Provider Demographics
NPI:1063303196
Name:DESHIELD, SHANI ROSE (FNP-C,FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHANI
Middle Name:ROSE
Last Name:DESHIELD
Suffix:
Gender:F
Credentials:FNP-C,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 SUMMERLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD PARK
Mailing Address - State:AB
Mailing Address - Zip Code:T8H 0R2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4248 SUMMERLAND DRIVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD PARK
Practice Address - State:AB
Practice Address - Zip Code:T8H 0R2
Practice Address - Country:CA
Practice Address - Phone:314-601-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP70002118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily