Healthcare Provider Details

I. General information

NPI: 1801611298
Provider Name (Legal Business Name): AMIN NEEL SHAYEGHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MOREHEAD MEDICAL DR
CHARLOTTE NC
28204-2990
US

IV. Provider business mailing address

913 KENYON CT
CHARLOTTE NC
28211-5689
US

V. Phone/Fax

Practice location:
  • Phone: 980-442-4400
  • Fax:
Mailing address:
  • Phone: 704-231-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number14431
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: