Healthcare Provider Details

I. General information

NPI: 1003009838
Provider Name (Legal Business Name): SHRUTI VIJAYA SIMHA M.D., M.P.H
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 400
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

301 E WENDOVER AVE STE 400
GREENSBORO NC
27401-1230
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3150
  • Fax: 336-832-3151
Mailing address:
  • Phone: 336-832-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007-01338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: