Shane Megan Sundlie, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2021-01125 Issued in NC

Practice address

403 Fairview St
Clinton, NC 28328-2399

Phone

(910) 592-6011

Fax

(910) 592-0819

NPI assigned

May 31, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clinton Medical Clinic, Inc.

  • General Practice Physician
  • Clinton, NC
  • NPI 1780629154

  Pediatrics

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657238400000",
    "number": "1154813764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 FAIRVIEW ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282399",
            "telephone_number": "910-592-6011",
            "fax_number": "910-592-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 FAIRVIEW ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282399",
            "telephone_number": "910-592-6011",
            "fax_number": "910-592-0819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDLIE",
        "first_name": "SHANE",
        "middle_name": "MEGAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-31",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2021-01125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shanesundlie@cmci.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Clinton Medical Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "403 Fairview St",
            "city": "Clinton",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283282399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren Preddy Spell, OTD, OTR/L
• Toni Victoria Spell, LCMHC-A
• Robert Thomas Stagnitta
• Mickael John Stephens, BS
• Gaye Sullinger
• John Peeler Surratt, MD
• Adam Sutphin
• Frances Elizabeth Sutton, FNP
• Alexandra Victoria Taylor
• Cynthia L Taylor

• Pediatrics Physician in Clinton, NC
• Providers in Clinton, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.