Healthcare Provider Details

I. General information

NPI: 1558002964
Provider Name (Legal Business Name): SHAE BRIANNE HUSTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-413-6202
  • Fax:
Mailing address:
  • Phone: 252-744-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-01151
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: