Provider Demographics
NPI:1245208529
Name:WEIR, SHAWNEE D
Entity Type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:D
Last Name:WEIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 BLUE RIDGE RD
Mailing Address - Street 2:STE 320
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6462
Mailing Address - Country:US
Mailing Address - Phone:919-876-7692
Mailing Address - Fax:919-954-3365
Practice Address - Street 1:2709 BLUE RIDGE RD
Practice Address - Street 2:STE 320
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6462
Practice Address - Country:US
Practice Address - Phone:919-876-7692
Practice Address - Fax:919-954-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26882207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00166091OtherMCR RR
NC8912485Medicaid
NCP00629149OtherRR MEDICARE
NC12485OtherBCBS
NC8912485Medicaid
NC12485OtherBCBS
NCP00166091OtherMCR RR