Healthcare Provider Details

I. General information

NPI: 1730380239
Provider Name (Legal Business Name): MAX SHENIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 DOCTORS CIR BLDG C
WILMINGTON NC
28401-7403
US

IV. Provider business mailing address

PO BOX 936857
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-7550
  • Fax: 910-662-7551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2018-02982
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: