Healthcare Provider Details

I. General information

NPI: 1548569791
Provider Name (Legal Business Name): SHRUTI MUKUND RAJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2011
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DUKE MEDICINE CIR CLINIC 1L
DURHAM NC
27710-4000
US

IV. Provider business mailing address

NEUROMUSCULAR CLINIC DUMC 3403
DURHAM NC
27710-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-5422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number2015-01649
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: