=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831184969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHISHIR HASMUKHLAL SHAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2005
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 PROGRESS BLVD
-----------------------------------------------------
City | SILER CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27344-6787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-786-6428
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 EOFF ST
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003-3823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-234-8663
-----------------------------------------------------
Fax | 304-234-8960
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | 19498
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 2017-00040
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 19498
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------