Healthcare Provider Details

I. General information

NPI: 1760464663
Provider Name (Legal Business Name): SHAWN MICHELLE DALTON-BETHEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 BLAIR ST
THOMASVILLE NC
27360-4359
US

IV. Provider business mailing address

PO BOX 38728
GREENSBORO NC
27438-8728
US

V. Phone/Fax

Practice location:
  • Phone: 201-654-6397
  • Fax: 201-608-9241
Mailing address:
  • Phone: 336-501-3796
  • Fax: 336-333-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number21959
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD423882
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2007-00213
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: