Healthcare Provider Details

I. General information

NPI: 1790075828
Provider Name (Legal Business Name): DHVANI SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 BLUE RIDGE RD
RALEIGH NC
27612-8010
US

IV. Provider business mailing address

3237 BLUE RIDGE RD
RALEIGH NC
27612-8010
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-7500
  • Fax:
Mailing address:
  • Phone: 919-781-7500
  • Fax:

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 Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD045061
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: