Basic Information
| Provider Information | |||||||||
| NPI: | 1477637080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINGLETON | ||||||||
| FirstName: | SHAUNESE | ||||||||
| MiddleName: | DERAE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 PARK ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280125205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048290025 | ||||||||
| FaxNumber: | 7048290031 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 PARK ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280125205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048290025 | ||||||||
| FaxNumber: | 7048290031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 12/16/2013 | ||||||||
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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 | 208000000X | 200100958 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 229425 | 05 | SC | MEDICAID | 5905500 | 05 | NC | MEDICAID |