Healthcare Provider Details

I. General information

NPI: 1346209665
Provider Name (Legal Business Name): MICHOL SHAW NEGRON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHOL SHAW JELNICKY

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S ALLEN RD
FLAT ROCK NC
28731-9447
US

IV. Provider business mailing address

571 S ALLEN RD
FLAT ROCK NC
28731-9447
US

V. Phone/Fax

Practice location:
  • Phone: 828-692-6178
  • Fax: 828-692-2365
Mailing address:
  • Phone: 828-692-6178
  • Fax: 828-692-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-00079
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number260794
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: