Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shantorius Shantae Stacks, FNP

Individual provider Family Nurse Practitioner · NPI 1790489961

Shantorius Shantae Stacks, FNP is a Nurse Practitioner in Atlanta, Georgia. Qualified in 2022, 4 years ago. Practices with Wellstreet of Georgia PC, a 431-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
4
Licensed in
GA
In the registry since
2023
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

2219 Benidorm Ct
Atlanta, GA 30349-8497
Phone: (770) 572-7109
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN-NP256370 (GA)

Record details

NPI number1790489961
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedMarch 29, 2023
Last updated in NPPESOctober 29, 2025
Certification dateOctober 29, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Wellstreet Of Georgia Pc — 431 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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