Provider Demographics
NPI:1508276775
Name:KIRK, SHAWN A (BOCP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:A
Last Name:KIRK
Suffix:
Gender:M
Credentials:BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 E MILLBROOK RD
Mailing Address - Street 2:101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1746
Mailing Address - Country:US
Mailing Address - Phone:919-510-4131
Mailing Address - Fax:919-510-4132
Practice Address - Street 1:2231 E MILLBROOK RD
Practice Address - Street 2:101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1746
Practice Address - Country:US
Practice Address - Phone:919-510-4131
Practice Address - Fax:919-510-4132
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist