Healthcare Provider Details

I. General information

NPI: 1871414102
Provider Name (Legal Business Name): SHARDAE VANHOOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 MALLARD CREEK RD STE 300
CHARLOTTE NC
28262-6001
US

IV. Provider business mailing address

4216 BOWLINE DR
CHARLOTTE NC
28269-3102
US

V. Phone/Fax

Practice location:
  • Phone: 980-335-7702
  • Fax:
Mailing address:
  • Phone: 980-335-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: