Provider Demographics
NPI:1831721125
Name:EVANS, SHAMORI
Entity type:Individual
Prefix:
First Name:SHAMORI
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 BENNETTSVILLE LN APT 208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3515
Mailing Address - Country:US
Mailing Address - Phone:336-451-4179
Mailing Address - Fax:
Practice Address - Street 1:6125 BENNETTSVILLE LN APT 208
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3515
Practice Address - Country:US
Practice Address - Phone:336-451-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide