Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Wylder Shepherd Fondaw, PA

Individual provider Medical Physician Assistant · NPI 1205450400

Wylder Shepherd Fondaw, PA is a Medical Physician Assistant in Greensboro, North Carolina. Licensed in North Carolina. Registered with an NPI since 2020.

Licensed in
NC
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1126 N Church St
Greensboro, NC 27401-1000
Phone: (336) 832-7000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-10234 (NC)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1205450400
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJune 3, 2020
Last updated in NPPESJuly 18, 2023
Certification dateJuly 18, 2023

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