Healthcare Provider Details

I. General information

NPI: 1740689124
Provider Name (Legal Business Name): SHRIJA SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 FALLS OF NEUSE RD STE 200
RALEIGH NC
27609-6269
US

IV. Provider business mailing address

4400 FALLS OF NEUSE RD STE 200
RALEIGH NC
27609-6269
US

V. Phone/Fax

Practice location:
  • Phone: 919-954-8570
  • Fax:
Mailing address:
  • Phone: 919-954-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9809
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: