Provider Demographics
NPI:1720565138
Name:DUNCAN, SHAYNA ERLISA (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:ERLISA
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 FOREST RUN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3532
Mailing Address - Country:US
Mailing Address - Phone:980-322-1908
Mailing Address - Fax:
Practice Address - Street 1:4000 TUCKASEEGEE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2832
Practice Address - Country:US
Practice Address - Phone:704-523-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO127591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical