Healthcare Provider Details

I. General information

NPI: 1831184969
Provider Name (Legal Business Name): SHISHIR HASMUKHLAL SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 PROGRESS BLVD
SILER CITY NC
27344-6787
US

IV. Provider business mailing address

2000 EOFF ST
WHEELING WV
26003-3823
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-6428
  • Fax:
Mailing address:
  • Phone: 304-234-8663
  • Fax: 304-234-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number19498
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2017-00040
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19498
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: