Provider Demographics
NPI:1366741993
Name:YOURSHAW, NIKKI ELIZABETH (MD, MPH)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:ELIZABETH
Last Name:YOURSHAW
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:ELIZABETH
Other - Last Name:WALDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:2295 E 14TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-6804
Practice Address - Country:US
Practice Address - Phone:336-713-8860
Practice Address - Fax:336-713-8862
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451556208000000X
SCTL37991208000000X
NC2025-00521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics