Healthcare Provider Details

I. General information

NPI: 1700053063
Provider Name (Legal Business Name): TONI LEE SHELOW ED.S., PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 MERRYVALE LN
CHARLOTTE NC
28214-2659
US

IV. Provider business mailing address

8225 MERRYVALE LN
CHARLOTTE NC
28214-2659
US

V. Phone/Fax

Practice location:
  • Phone: 828-222-6048
  • Fax: 828-484-1976
Mailing address:
  • Phone: 828-222-6048
  • Fax: 828-484-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6668
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3479
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6668
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6668
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3479
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3479
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: