Provider Demographics
NPI:1336916055
Name:DOVE, SHANE ALLAN
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:ALLAN
Last Name:DOVE
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 1:2680 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-9095
Mailing Address - Country:US
Mailing Address - Phone:336-639-8990
Mailing Address - Fax:336-639-7266
Practice Address - Street 1:2680 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9095
Practice Address - Country:US
Practice Address - Phone:336-639-8990
Practice Address - Fax:336-639-7266
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health