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General NPI Number Information
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NPI Number | 1770624637
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Entity Type | Organization
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Legal Business Name | FOOTHILLS CONSULTING ASSOCIATES LLC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 03/30/2019
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Provider Practice Location Address
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Address Line | 615 S DEKALB ST
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City | SHELBY
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State | NC
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Zip | 28150-6184
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Country | US
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Telephone | 704-480-1882
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Fax | 704-480-1832
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Provider Business Mailing Address
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Address Line | PO BOX 1418
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City | SHELBY
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State | NC
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Zip | 28151-1418
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Country | US
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Telephone | 704-480-1882
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Fax | 704-480-1832
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Authorized Official
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Title or Position | PHYSICIAN
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Name | NILIMA DAFTARY SHUKLA
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Credential | MD
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Telephone | 704-480-1882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20933553
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License Number State | NC
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