=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083631832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMIL J. MORAYATI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 06/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2921 CROUSE LN
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-585-1212
-----------------------------------------------------
Fax | 336-585-1112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2921 CROUSE LN
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-8833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-585-1212
-----------------------------------------------------
Fax | 336-585-1112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 33871
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------