Provider Demographics
NPI:1710498738
Name:BOWMAN, SHAUN ELIZABETH
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:ELIZABETH
Last Name:BOWMAN
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 1:2214 MARKHAM CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-4142
Mailing Address - Country:US
Mailing Address - Phone:704-307-1165
Mailing Address - Fax:
Practice Address - Street 1:505 OBERLIN RD STE 230
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1345
Practice Address - Country:US
Practice Address - Phone:704-307-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician