Provider Demographics
NPI:1104891902
Name:RINKER, SHELLEY H (MD)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:H
Last Name:RINKER
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-664-2552
Mailing Address - Fax:704-664-5382
Practice Address - Street 1:133 WELTON WAY
Practice Address - Street 2:SUITE C
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-664-2552
Practice Address - Fax:704-664-5382
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35735208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012P1Medicaid
NC8971867Medicaid
NC012P1OtherBCBS
NC71867OtherBCBS
NC012P1OtherBCBS