Healthcare Provider Details

I. General information

NPI: 1518147339
Provider Name (Legal Business Name): SHELLI L. BREWINGTON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 METROMEDICAL DR
FAYETTEVILLE NC
28304-3861
US

IV. Provider business mailing address

1738 METROMEDICAL DR
FAYETTEVILLE NC
28304-3861
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4191
  • Fax:
Mailing address:
  • Phone: 910-484-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number525
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: