Healthcare Provider Details

I. General information

NPI: 1255745188
Provider Name (Legal Business Name): BHAIRAVI SHESHADRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 BLUE RIDGE RD STE 320
RALEIGH NC
27607-6462
US

IV. Provider business mailing address

2709 BLUE RIDGE RD STE 320
RALEIGH NC
27607-6462
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-7692
  • Fax: 919-954-3365
Mailing address:
  • Phone: 919-876-7692
  • Fax: 919-954-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2021-00280
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: