MEDICARE: SHANA DANETTE JAMES-NZAMBELE MD

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	207Q00000X	Family Medicine Physician	20238	SC
2	207Q00000X	Family Medicine Physician	9601158	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932152121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA DANETTE JAMES-NZAMBELE MD

Provider Business Mailing Address
First Line	:	200 E SECOND AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4358
Country	:	US
Telephone Number	:	704-874-1904
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E THIRD AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4343
Country	:	US
Telephone Number	:	704-874-3300
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	10/21/2019

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