Healthcare Provider Details

I. General information

NPI: 1841967031
Provider Name (Legal Business Name): SHAWN TREADWAY RT (R) (CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWN DAVIS RT (R) (CT)

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

IV. Provider business mailing address

12 TWELVE OAKS DR
ASHEVILLE NC
28805-0034
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax:
Mailing address:
  • Phone: 828-779-8936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number254542
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: