Healthcare Provider Details

I. General information

NPI: 1184100901
Provider Name (Legal Business Name): KEVIN JAMES SHEFFERLY MMS IN PA STUDIES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2018
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHARLOIS BLVD
WINSTON SALEM NC
27103-1522
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3361
  • Fax:
Mailing address:
  • Phone: 704-295-3000
  • Fax: 704-295-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: