Healthcare Provider Details

I. General information

NPI: 1710564893
Provider Name (Legal Business Name): ANDREW NICOLAS SHAMMAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4650
  • Fax: 336-716-4318
Mailing address:
  • Phone: 336-716-4650
  • Fax: 336-716-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP05363
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2025-03794
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: