Provider Demographics
NPI:1255166591
Name:SHONGUT, MEGAN NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:SHONGUT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8933 PENNEGROVE CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8138
Mailing Address - Country:US
Mailing Address - Phone:336-457-3572
Mailing Address - Fax:
Practice Address - Street 1:2391 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2196
Practice Address - Country:US
Practice Address - Phone:704-853-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner