Healthcare Provider Details

I. General information

NPI: 1770841132
Provider Name (Legal Business Name): SHAILESH MALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-5654
  • Fax: 252-847-4616
Mailing address:
  • Phone: 252-847-5654
  • Fax: 252-847-4616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number2018-02832
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: