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General NPI Number Information
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NPI Number | 1376748806
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Entity Type | Individual
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Provider Name | SHVETA SHAH RAJU M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 01/14/2023
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Provider Practice Location Address
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Address Line | 10600 MEDLOCK BRIDGE RD
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City | DULUTH
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State | GA
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Zip | 30097-8404
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Country | US
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Telephone | 770-418-0818
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Fax | 678-206-0156
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Provider Business Mailing Address
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Address Line | 10600 MEDLOCK BRIDGE RD
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City | DULUTH
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State | GA
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Zip | 30097-8404
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 241781
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 066052
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License Number State | GA
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