MEDICARE: SHONDU LYNCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	405300000X	Prevention Professional	12354	NC

General Provider Information

NPI Number	:	1598556342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONDU LYNCH

Provider Business Mailing Address
First Line	:	601 W 24TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28206-2516
Country	:	US
Telephone Number	:	704-363-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	719 EAST BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5113
Country	:	US
Telephone Number	:	704-363-8589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	05/13/2025

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Directions to “ SHONDU LYNCH ” Practice Location

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