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General NPI Number Information
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NPI Number | 1265065015
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Entity Type | Individual
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Provider Name | SHUBHAM TYAGI
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Gender | Male
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Dates
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Enumeration Date | 02/20/2020
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | DUKE URGENT CARE BRIER CREEK 10211 ALM STREET SUITE 1200
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City | RALEIGH
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State | NC
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Zip | 27617-2761
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Country | US
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Telephone | 814-321-1628
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Fax |
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Provider Business Mailing Address
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Address Line | 9403 CHASEMILL CT
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City | RALEIGH
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State | NC
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Zip | 27617-8556
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Country | US
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Telephone | 814-321-1628
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5012872
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License Number State | NC
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