Provider Demographics
NPI:1831122035
Name:ASAAD, SHONDA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:SHONDA
Middle Name:MICHELLE
Last Name:ASAAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 STATION STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-353-0819
Mailing Address - Fax:910-353-0828
Practice Address - Street 1:239 STATION ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6304
Practice Address - Country:US
Practice Address - Phone:910-353-0819
Practice Address - Fax:910-353-0828
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26720207RH0003X
NC2010-00129207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7040266OtherCIGNA
SC267204Medicaid
NC7090521OtherAETNA
NCP01121033OtherRR MEDICARE
NC7090521OtherAETNA
NCNC4869CMedicare PIN
SC267204Medicaid
SCH12543Medicare UPIN