Healthcare Provider Details

I. General information

NPI: 1104441328
Provider Name (Legal Business Name): ISHANGI DIVEKAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ISHANGI SHAH

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LLOYD ST
CARRBORO NC
27510-1823
US

IV. Provider business mailing address

2182 BRISTOL CREEK DR
MORRISVILLE NC
27560-7883
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-8741
  • Fax:
Mailing address:
  • Phone: 773-814-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: