Basic Information
| Provider Information | |||||||||
| NPI: | 1053542381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHINE | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | N.P. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SHINE | ||||||||
| OtherFirstName: | ANNE | ||||||||
| OtherMiddleName: | S. | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 601043 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192338585 | ||||||||
| FaxNumber: | 9192338566 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 ASHVILLE AVE | ||||||||
| Address2: | STE 310 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275188682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192338585 | ||||||||
| FaxNumber: | 9192338566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2009 | ||||||||
| LastUpdateDate: | 08/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 900185 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.