Healthcare Provider Details

I. General information

NPI: 1164418125
Provider Name (Legal Business Name): DEVENDRA C. SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 W ROOSEVELT BLVD
MONROE NC
28110-2818
US

IV. Provider business mailing address

284 EXECUTIVE PARK ROAD STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 704-296-6200
  • Fax: 704-296-4669
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number94-01028
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: