Healthcare Provider Details

I. General information

NPI: 1639132111
Provider Name (Legal Business Name): SCOTT MITCHELL SHEFLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 STAFFORD ST UNIT 6
MONROE NC
28110-3349
US

IV. Provider business mailing address

5004 SUNSET FAIRWAYS DR
HOLLY SPRINGS NC
27540-7829
US

V. Phone/Fax

Practice location:
  • Phone: 813-596-5726
  • Fax:
Mailing address:
  • Phone: 919-924-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number187321
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35751
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number35751
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: