Healthcare Provider Details

I. General information

NPI: 1629462700
Provider Name (Legal Business Name): ASHOK SHIANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 SILVER STREAM LN
WILMINGTON NC
28401-7684
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-3343
  • Fax: 910-341-3320
Mailing address:
  • Phone: 910-341-1540
  • Fax: 910-431-4048

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME137160
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2024-00854
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: