Healthcare Provider Details

I. General information

NPI: 1487498770
Provider Name (Legal Business Name): SHIREEN MANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SMITH AVE UNIT 5
SHALLOTTE NC
28470-4756
US

IV. Provider business mailing address

113 SMITH AVE UNIT 5
SHALLOTTE NC
28470-4756
US

V. Phone/Fax

Practice location:
  • Phone: 209-872-5722
  • Fax:
Mailing address:
  • Phone: 209-872-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14949
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: