Healthcare Provider Details

I. General information

NPI: 1497322531
Provider Name (Legal Business Name): SHAILJA AMIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 WINDSOR WAY
ELON NC
27244-9404
US

IV. Provider business mailing address

7007 WINDSOR WAY
ELON NC
27244-9404
US

V. Phone/Fax

Practice location:
  • Phone: 336-380-5405
  • Fax:
Mailing address:
  • Phone: 336-380-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10654
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: