Healthcare Provider Details

I. General information

NPI: 1366435828
Provider Name (Legal Business Name): LUANNE GARDNER SHEAFFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 DELANEY AVE
WILMINGTON NC
28403-6003
US

IV. Provider business mailing address

PO BOX 936857 DEPARTMENT 100
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-1122
  • Fax: 910-343-1999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL26-1243
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102917
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: