Healthcare Provider Details

I. General information

NPI: 1033165261
Provider Name (Legal Business Name): BANSI P SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3318 HEALY DR
WINSTON SALEM NC
27103-1404
US

IV. Provider business mailing address

3318 HEALY DR
WINSTON SALEM NC
27103-1404
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3530
  • Fax: 336-768-1329
Mailing address:
  • Phone: 336-768-3530
  • Fax: 336-768-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17432
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: