Provider Demographics
NPI:1871657924
Name:SHEARD, MYEONG O (DPM)
Entity Type:Individual
Prefix:DR
First Name:MYEONG
Middle Name:O
Last Name:SHEARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 TINSLEY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1532
Mailing Address - Country:US
Mailing Address - Phone:336-282-8787
Mailing Address - Fax:336-510-7284
Practice Address - Street 1:3931 TINSLEY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1532
Practice Address - Country:US
Practice Address - Phone:336-282-8787
Practice Address - Fax:336-510-7284
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC233213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890816BMedicaid
NC243121DMedicare PIN
NC890816BMedicaid