Provider Demographics
NPI:1477637080
Name:SINGLETON, SHAUNESE DERAE (MD)
Entity Type:Individual
Prefix:
First Name:SHAUNESE
Middle Name:DERAE
Last Name:SINGLETON
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 1:209 PARK ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-5205
Mailing Address - Country:US
Mailing Address - Phone:704-829-0025
Mailing Address - Fax:704-829-0031
Practice Address - Street 1:209 PARK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-5205
Practice Address - Country:US
Practice Address - Phone:704-829-0025
Practice Address - Fax:704-829-0031
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100958208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC229425Medicaid
NC5905500Medicaid
NC5905500Medicaid