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SHORE FUN PEDIATRICS
NPI 1750420428
Pediatrics in Supply, NC

Active since February 06, 2007CLIA 34D1016444 · Waiver
14 DOCTORS CIR, SUITE 3, SUPPLY, NC 28462(910) 754-7075(910) 754-2158 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shore Fun Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHORE FUN PEDIATRICS (NPI 1750420428) is a healthcare organization registered as a pediatrics in Supply, North Carolina and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through August 27, 2027 and lists Brucie Janelle Spivey-cochran, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1750420428
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameSHORE FUN PEDIATRICS
Location Address14 DOCTORS CIR, SUITE 3Supply, NC 28462-4097
Mailing Address14 Doctors Cir, Suite 3Supply, NC 28462-4097 · (910) 754-7075 · Fax (910) 754-2158
Phone(910) 754-7075
Fax(910) 754-2158
Organization SubpartNo
Authorized OfficialBrucie Janelle Spivey-cochranPractice Manager · (910) 754-7075
Enumeration DateFebruary 6, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1750420428 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
14 DOCTORS CIR, Supply, NC 28462
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D1016444

Shore Fun Pediatrics · Supply, NC
Active · expires Aug 27, 2027
CLIA Number34D1016444
Laboratory TypePhysician Office
Certificate Effective DateAugust 28, 2025
Certificate Expiration DateAugust 27, 2027
Laboratory DirectorAlicia Hope Tyndall
Laboratory Phone(910) 754-7075
Laboratory LocationShore Fun Pediatrics14 Doctors Circle Ste 3, Supply, NC 28462
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUSAN KADY WILSON M.D.
Obstetrics & Gynecology
14 DOCTORS CIR, SUITE 5
SUPPLY, NC 28462
Brunswick County (910) 754-9166
MRS. ALICIA HOPE TYNDALL FNP-BC
Nurse Practitioner (Family)
14 DOCTORS CIR, SUITE 3
SUPPLY, NC 28462
Brunswick County (910) 754-7075
MS. MARY BETH BARNA PNP-BC
Nurse Practitioner (Pediatrics)
14 DOCTORS CIR, SUITE 3
SUPPLY, NC 28462
Brunswick County (910) 754-7075
INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Podiatrist (Foot & Ankle Surgery)
14 DOCTORS CIR, SUITE 2
SUPPLY, NC 28462
Brunswick County (910) 755-6512
LARRY LEE WILSON MD
Obstetrics & Gynecology
14 DOCTORS CIR, SUITE 5
SUPPLY, NC 28462
Brunswick County (910) 754-9166
BRUNSWICK FOOT & ANKLE SURGERY
Clinic/Center (Podiatric)
14 DOCTORS CIR, SUITE 2
SUPPLY, NC 28462
Brunswick County (919) 751-9120
DR. JOSEPH F KIBLER DPM
Podiatrist (Primary Podiatric Medicine)
14 DOCTORS CIR, SUITE 2
SUPPLY, NC 28462
Brunswick County (910) 755-6512
NORTH CAROLINA PHYSICIAN NETWORK, INC.
Obstetrics & Gynecology
14 DOCTORS CIR, SUITE 5
SUPPLY, NC 28462
Brunswick County (910) 754-9166

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shore Fun Pediatrics's NPI number?

The NPI number for Shore Fun Pediatrics is 1750420428. It was assigned to this organization in the NPPES registry on February 6, 2007.

Where is Shore Fun Pediatrics located?

Shore Fun Pediatrics is located at 14 Doctors Cir Suite 3, Supply, NC 28462. The listed phone number is (910) 754-7075.

What is Shore Fun Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Shore Fun Pediatrics hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D1016444) is associated with this NPI, valid through August 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shore Fun Pediatrics was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.