Provider Demographics
NPI:1891933891
Name:CAVINESS, SHANI D (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANI
Middle Name:D
Last Name:CAVINESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11208 STATESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7635
Mailing Address - Country:US
Mailing Address - Phone:704-659-9000
Mailing Address - Fax:
Practice Address - Street 1:11208 STATESVILLE RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7635
Practice Address - Country:US
Practice Address - Phone:704-659-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant