Provider Demographics
NPI:1265710446
Name:ERKLIN, SHANNON V (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:V
Last Name:ERKLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BERGERON WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6669
Mailing Address - Country:US
Mailing Address - Phone:919-263-4177
Mailing Address - Fax:
Practice Address - Street 1:211 E SIX FORKS RD
Practice Address - Street 2:STE 114
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7753
Practice Address - Country:US
Practice Address - Phone:919-263-4177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IL071008673103TC0700X, 103TC2200X
NC5431103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILF400201817OtherMEDICARE PTAN (INDIVIDUAL)