Provider Demographics
NPI:1497785430
Name:KANELOS, SHARON K (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:K
Last Name:KANELOS
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 1:11220 ELM LN STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0716
Mailing Address - Country:US
Mailing Address - Phone:704-557-0500
Mailing Address - Fax:704-541-5000
Practice Address - Street 1:11220 ELM LN STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0716
Practice Address - Country:US
Practice Address - Phone:704-557-5000
Practice Address - Fax:704-541-5000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00479208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497785430Medicaid
SCN00471Medicaid
NC89127XEMedicaid
NC127XEOtherNCBCBS
NC1497785430Medicaid
NC2280919Medicare PIN
NCH23972Medicare UPIN
NC89127XEMedicaid