Provider Demographics
NPI:1114962289
Name:ANKRAH, SHELIA DELOISE (MD)
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:DELOISE
Last Name:ANKRAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1000
Mailing Address - Fax:704-384-1012
Practice Address - Street 1:2630 E 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4319
Practice Address - Country:US
Practice Address - Phone:704-384-1000
Practice Address - Fax:704-384-1012
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71910208000000X
NC2007-01096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1114962289Medicaid
NC5907619Medicaid
CAGR0095780, 00A719100Medicaid