Provider Demographics
NPI:1588811038
Name:CAPUTO, SHAWNE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAWNE
Middle Name:
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8936 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6660
Mailing Address - Country:US
Mailing Address - Phone:704-943-3714
Mailing Address - Fax:704-943-3719
Practice Address - Street 1:8936 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6660
Practice Address - Country:US
Practice Address - Phone:704-943-3714
Practice Address - Fax:704-943-3719
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2753041COtherMEDICARE PTAN