Healthcare Provider Details

I. General information

NPI: 1952369761
Provider Name (Legal Business Name): HARBORSIDE PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WILLIAMSON RD STE 100
MOORESVILLE NC
28117-5966
US

IV. Provider business mailing address

311 WILLIAMSON RD STE 100
MOORESVILLE NC
28117-5966
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: DR. SHELLEY H RINKER
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 704-664-2552