Healthcare Provider Details

I. General information

NPI: 1659923365
Provider Name (Legal Business Name): SHIVANI BHATT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 GOLDEN SPUR LN STE 104
WENDELL NC
27591
US

IV. Provider business mailing address

1903 GOLDEN SPUR LN STE 104
WENDELL NC
27591
US

V. Phone/Fax

Practice location:
  • Phone: 919-346-8678
  • Fax: 919-346-8679
Mailing address:
  • Phone: 919-346-8678
  • Fax: 919-346-8679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024694
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: