Healthcare Provider Details

I. General information

NPI: 1598450884
Provider Name (Legal Business Name): SHREYA SHAMBHAVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date: 11/17/2023
Reactivation Date: 05/19/2025

III. Provider practice location address

3100 MACCORKLE AVE SE STE 302
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 302
CHARLESTON WV
25304-1223
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5967
  • Fax:
Mailing address:
  • Phone: 304-388-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: