Healthcare Provider Details

I. General information

NPI: 1710085782
Provider Name (Legal Business Name): MICHAEL SHANE STALVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-1711
US

IV. Provider business mailing address

2725 4TH AVE S UNIT 4E
BIRMINGHAM AL
35233-2734
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-4500
  • Fax: 336-713-4501
Mailing address:
  • Phone: 205-915-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number2021-02006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: