Healthcare Provider Details

I. General information

NPI: 1316574031
Provider Name (Legal Business Name): DR. TONI SHELOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TONI LEE SHELOW
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 828-222-6048