SHAWN VAN WALLENDAEL (NPI# 1376570689) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376570689 |
| Entity Type | Individual |
| Full Name | SHAWN VAN WALLENDAEL |
| Credential | PA |
| Practice Address |
10648 Park Rd Charlotte NC 28210-8407 |
| Mailing Address |
Po Box 19305 Charlotte NC 28219-9305 |
| Practice Telephone | 7043559330 |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-09-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 103076 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 101 E Wt Harris Blvd, Building 1000, Ste 1110, Charlotte, NC 282623485 | 7048639850 | |
| 1100 Blythe Blvd, Charlotte, NC 282035814 | 7043559330 | |
| 275 Beatty Dr, Belmont, NC 280122715 | 7043559330 | |
| 487 Lake Concord Rd Ne, Concord, NC 280252934 | 7044030300 |
| Street Address |
10648 PARK RD |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28210-8407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912507732 | Payeng Lee | Nurse Practitioner | 10648 Park Rd, Charlotte, NC 28210-8407 | 2020-10-30 |
| 1275153462 | Darius Ingram | Occupational Therapist | 10648 Park Rd, Charlotte, NC 28210-8407 | 2020-04-17 |
| 1114553286 | Jamie Savarino | Physical Medicine & Rehabilitation | 10648 Park Rd, Charlotte, NC 28210-8407 | 2020-03-20 |
| 1962987131 | The Charlotte-mecklenburg Hospital Authority | Rehabilitation Unit | 10648 Park Rd, Charlotte, NC 28210-8407 | 2018-10-03 |
| 1144607029 | Chandee Payne | Physical Medicine & Rehabilitation | 10648 Park Rd, Charlotte, NC 28210-8407 | 2015-04-30 |
| 1104216217 | Lesley Saunders | Speech-Language Pathologist | 10648 Park Rd, Charlotte, NC 28210-8407 | 2015-01-27 |
| 1477943728 | Anna Edwards | Physical Therapist | 10648 Park Rd, Charlotte, NC 28210-8407 | 2015-01-26 |
| 1023416229 | Kimberly Aronson | Occupational Therapist | 10648 Park Rd, Charlotte, NC 28210-8407 | 2014-12-21 |
| 1306243654 | Tara Brown | Occupational Therapist | 10648 Park Rd, Charlotte, NC 28210-8407 | 2014-12-02 |
| 1639576234 | Karla Collins | Occupational Therapist | 10648 Park Rd, Charlotte, NC 28210-8407 | 2014-11-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952920860 | Rx Care 14 LLC | Pharmacy | 7701 Sharon Lakes Road, Suite H, Charlotte, NC 28210 | 2020-04-10 |
| 1427697622 | David Durant Dinsmore | Nurse Anesthetist, Certified Registered | Atrium Health Pineville, 10628 Park Road, Charlotte, NC 28210 | 2020-01-06 |
| 1790256964 | Tele Phys Inc | Internal Medicine | 10035 Park Center Dr., Ste 100, Charlotte, NC 28210 | 2018-12-16 |
| 1104395896 | Bridgett Williams | Behavior Technician | 7806 Andover Woods Drive, Charlotte, NC 28210 | 2018-11-26 |
| 1053880518 | Low-t Physicians Professional Association | Internal Medicine | 10430 Park Road Suite 100a, Charlotte, NC 28210 | 2018-11-14 |
| 1053895102 | Carolinas Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 7701 Sharon Lakes Blvd, Ste A., Charlotte, NC 28210 | 2018-09-24 |
| 1679066658 | Afc Urgent Care and Family Care of Wnc, Pllc | Clinic/Center | 10102 Johnston Rd, Charlotte, NC 28210 | 2018-06-13 |
| 1346777018 | Hopeway Foundation | Clinic/Center | 1717 Sharon Road West, Charlotte, NC 28210 | 2017-05-12 |
| 1891154688 | Jessie Lee Ogienko | Social Worker | 5960 Fairview Rd Ste 328, Charlotte, NC 28210 | 2016-02-22 |
| 1699151985 | Carolina Complete Psychiatry, Pllc | Physician Assistant | 5950 Fairview Road, Suite 708, Charlotte, NC 28210 | 2015-08-10 |
| Find all providers in zip 28210 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396351607 | Michael James Blackwell | Physician Assistant | 501 Billingsley Rd Ste B, Charlotte, NC 28211-1009 | 2020-09-22 |
| 1598371320 | Jonathan Byron Lively | Physician Assistant | 1000 Blythe Blvd Fl 3, Charlotte, NC 28203-5812 | 2020-09-17 |
| 1902415532 | Jacqueline Ellen Leyrer | Physician Assistant | 2630 E 7th St Ste 200, Charlotte, NC 28204-4319 | 2020-07-29 |
| 1750908380 | Whitney Debroy | Physician Assistant | 125 W Tremont Ave Unit 726, Charlotte, NC 28203-5551 | 2020-06-30 |
| 1972129302 | Ashley Nicole Short | Physician Assistant | 1022 E Worthington Ave, Charlotte, NC 28203-5760 | 2020-06-22 |
| 1558985176 | Courtney Claugus | Physician Assistant | 300 E Park Ave Unit 7, Charlotte, NC 28203-4774 | 2020-05-29 |
| 1467071738 | Patrick James Quinn | Physician Assistant | 2036 Millerton Ave Apt 4311, Charlotte, NC 28208-5290 | 2020-04-15 |
| 1225660301 | Sunil Ranchhod Ghodasara | Physician Assistant | 1001 Blythe Blvd Ste 403, Charlotte, NC 28203-5863 | 2020-02-06 |
| 1225668601 | Emily Rebecca Markey | Physician Assistant | 355 W Mlk Blvd Apt 1112, Charlotte, NC 28202-0043 | 2020-01-24 |
| 1639719586 | Abosede Elizabeth Adamson | Physician Assistant | 3101 Amesbury Hill Dr, Charlotte, NC 28269-8951 | 2020-01-08 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.