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General NPI Number Information
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NPI Number | 1386641728
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Entity Type | Individual
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Provider Name | SHASHANK MISHRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 10/25/2020
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Provider Practice Location Address
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Address Line | 4815 BEREWICK TOWN CENTER DR STE C&D
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City | CHARLOTTE
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State | NC
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Zip | 28278-6733
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Country | US
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Telephone | 980-337-4652
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Fax | 980-337-4653
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Provider Business Mailing Address
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Address Line | PO BOX 601843
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City | CHARLOTTE
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State | NC
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Zip | 28260-1843
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2003-01021
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License Number State | NC
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