Riva Aesthetic Dermatology, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

39997 Issued in NC

Legal business name

RIVA AESTHETIC DERMATOLOGY, PLLC

Practice address

17039 Kenton Dr
Suite 100
Cornelius, NC 28031-5775

Phone

(704) 607-1518

NPI assigned

Jul 13, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Kerry Mark Shafran, M.D.

Title

Managing Physician

Phone

(704) 607-1518

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342137600000",
    "number": "1285999490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17039 KENTON DR",
            "address_2": "SUITE 100",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280315775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17039 KENTON DR",
            "address_2": "SUITE 100",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280315775",
            "telephone_number": "704-607-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVA AESTHETIC DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-13",
        "status": "A",
        "authorized_official_last_name": "SHAFRAN",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "MANAGING PHYSICIAN",
        "authorized_official_telephone_number": "704-607-1518",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "39997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashlee Reynolds
• Karola Dellemann Richardson, MA, LCMHC-A, NCC
• Jonathan Michael Riemer
• Mekenzie Lynn Riley, RD
• Jean-Pierre Alain Riou, M.D.
• Brittany Roberts
• Michaela Lynne Roberts, MD
• Michelle Robertson, P.T.
• Cecile Theresa Robes, DO
• Robert Lee Robinson

• Specialist in Cornelius, NC
• Providers in Cornelius, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.