Provider Demographics
NPI:1689273104
Name:POMALES, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:POMALES
Suffix:
Gender:M
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 2810
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-2810
Mailing Address - Country:US
Mailing Address - Phone:828-989-8686
Mailing Address - Fax:
Practice Address - Street 1:2250 CHAPEL AVE W STE 120
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2051
Practice Address - Country:US
Practice Address - Phone:866-853-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist