Healthcare Provider Details

I. General information

NPI: 1053542381
Provider Name (Legal Business Name): SHEILA A. SHINE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE S. SHINE

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ASHVILLE AVE STE 310
CARY NC
27518-8682
US

IV. Provider business mailing address

P.O. BOX 601043
CHARLOTTE NC
28260-1043
US

V. Phone/Fax

Practice location:
  • Phone: 919-233-8585
  • Fax: 919-233-8566
Mailing address:
  • Phone: 919-233-8585
  • Fax: 919-233-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number900185
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: