Healthcare Provider Details

I. General information

NPI: 1033045091
Provider Name (Legal Business Name): SHAVONNE MARSH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 WALKER AVE
GREENSBORO NC
27403
US

IV. Provider business mailing address

911 HUFFINE MILL RD
GREENSBORO NC
27405-6237
US

V. Phone/Fax

Practice location:
  • Phone: 336-430-3044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number346776
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: