Active NPI
Miesha Shineaquah Frederick
- Massage Therapist
- Charlotte, NC
National Provider Identifier
1497617831
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 10674
- Practice address
- 2643 Clydesdale Ter
Charlotte, NC 28208-4133 - Phone
- (704) 724-9394
- NPI assigned
- Nov 24, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 570855 | NC | |
| Massage Therapist | 225700000X | 10674 | SC | Primary |
Addresses
Primary practice location
2643 Clydesdale Ter
Charlotte, NC 28208-4133
Mailing address
2643 Clydesdale Ter
Charlotte, NC 28208-4133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10674 | SC | MD | Mental Health Counselor |
| 570855 | NC | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764028800000",
"number": "1497617831",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2643 CLYDESDALE TER",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282084133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2643 CLYDESDALE TER",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282084133",
"telephone_number": "704-724-9394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "MIESHA",
"middle_name": "SHINEAQUAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-24",
"last_updated": "2025-11-25",
"certification_date": "2025-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "NC",
"license": "570855",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "SC",
"license": "10674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.