Healthcare Provider Details

I. General information

NPI: 1174627566
Provider Name (Legal Business Name): ANN H. SHANKAR CNS, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILLINGSLEY ROAD BEHAVIORAL HEALTH CENTER CMC RANDOLPH
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-358-2700
  • Fax: 704-358-2716
Mailing address:
  • Phone: 704-358-2700
  • Fax: 704-358-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200792
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number100861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: