Provider Demographics
NPI:1932558582
Name:STITH, SHELLY
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:STITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:STITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10719 WHITTERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-9207
Mailing Address - Country:US
Mailing Address - Phone:704-787-1834
Mailing Address - Fax:
Practice Address - Street 1:10719 WHITTERSHAM DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9207
Practice Address - Country:US
Practice Address - Phone:704-787-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator