Healthcare Provider Details

I. General information

NPI: 1932152121
Provider Name (Legal Business Name): SHANA DANETTE JAMES-NZAMBELE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E THIRD AVE
GASTONIA NC
28052-4343
US

IV. Provider business mailing address

200 E SECOND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-3300
  • Fax:
Mailing address:
  • Phone: 704-874-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20238
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9601158
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: