SHORE FUN PEDIATRICS NPI 1750420428

NPI Information

  • NPI: 1750420428
  • Provider Name: SHORE FUN PEDIATRICS
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 34D1016444
  • Address: 14 DOCTORS CIR
    SUITE 3
    SUPPLY, NC
    ZIP 28462
  • Phone: (910) 754-7075

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NPI Details

SHORE FUN PEDIATRICS is a pediatrics in Supply, NC. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SHORE FUN PEDIATRICS NPI is 1750420428. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

14 DOCTORS CIR
SUITE 3
SUPPLY, NC
ZIP 28462-097
Phone: (910) 754-7075
Fax: (910) 754-2158

The provider's authorized official is Brucie Janelle Spivey-cochran .
The authorized official title is Practice Manager and has the following contact phone number (910) 754-7075.

The CLIA number assigned to this NPI record is 34D1016444 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/6/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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