Provider Demographics
NPI:1730075144
Name:JOHNSTON, SHAE ASHLEY
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:ASHLEY
Last Name:JOHNSTON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 CAMDEN RD APT 319
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6553
Mailing Address - Country:US
Mailing Address - Phone:912-506-1451
Mailing Address - Fax:
Practice Address - Street 1:4949 PROFESSIONAL PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-8638
Practice Address - Country:US
Practice Address - Phone:704-938-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program