Provider Demographics
NPI:1639780133
Name:WEAVER, SHEILA
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:WEAVER
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:PO BOX 621921
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9711 DAVID TAYLOR DR APT 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2370
Practice Address - Country:US
Practice Address - Phone:704-910-0136
Practice Address - Fax:866-800-2456
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104100000X, 133N00000X, 171M00000X, 174H00000X, 253Z00000X, 374J00000X
NC2019596001175T00000X
NCP0140271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist
No253Z00000XAgenciesIn Home Supportive Care
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty