Basic Information
| Provider Information | |||||||||
| NPI: | 1518588714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEIN | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PEDIATRIC EDUCATION OFFICE CB 7593 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199663172 | ||||||||
| FaxNumber: | 9199668419 | ||||||||
| Practice Location | |||||||||
| Address1: | 1512 E FRANKLIN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849746669 | ||||||||
| FaxNumber: | 9849749609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2020 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 261319 | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.