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General NPI Number Information
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NPI Number | 1023827342
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Entity Type | Organization
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Legal Business Name | SHAPED HEALTH AND WELLNESS
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 2020 REMOUNT RD STE E-105
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City | GASTONIA
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State | NC
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Zip | 28054-7476
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Country | US
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Telephone | 704-931-8286
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 REMOUNT RD STE E105
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City | GASTONIA
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State | NC
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Zip | 28054-7476
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CHRISTYLE RAINEY
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Credential |
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Telephone | 704-678-2403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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