Provider Demographics
NPI:1730448184
Name:SHIOZAKI, TEISHA (MD)
Entity type:Individual
Prefix:
First Name:TEISHA
Middle Name:
Last Name:SHIOZAKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 MOREHEAD MEDICAL DR STE 6200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2994
Mailing Address - Country:US
Mailing Address - Phone:801-557-9538
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR STE 6200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2994
Practice Address - Country:US
Practice Address - Phone:980-442-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-00485208600000X
IDM-14333208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery