Healthcare Provider Details

I. General information

NPI: 1104891902
Provider Name (Legal Business Name): SHELLEY H. RINKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 WELTON WAY SUITE C
MOORESVILLE NC
28117
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-2552
  • Fax: 704-664-5382
Mailing address:
  • Phone: 704-664-2552
  • Fax: 704-664-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35735
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: