Healthcare Provider Details

I. General information

NPI: 1598556342
Provider Name (Legal Business Name): SHONDU LYNCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 EAST BLVD
CHARLOTTE NC
28203-5113
US

IV. Provider business mailing address

601 W 24TH ST
CHARLOTTE NC
28206-2516
US

V. Phone/Fax

Practice location:
  • Phone: 704-363-8589
  • Fax:
Mailing address:
  • Phone: 704-363-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number12354
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: