Healthcare Provider Details

I. General information

NPI: 1710371810
Provider Name (Legal Business Name): AREZU SHEKARI-GUPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AREZU SHEKARI

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7093
  • Fax:
Mailing address:
  • Phone: 919-784-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05666
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: