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NPI Code Detail

MEDICARE: DR. DEVENDRA C. SHAH M.D.

MEDICARE: DR. DEVENDRA C. SHAH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician94-01028NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2C3258-B0775OTHERNCMEDCOST
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42086026OTHERNC2086026

General Provider Information

NPI Number : 1164418125
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEVENDRA C. SHAH M.D.
Provider Business Mailing Address
First Line : 284 EXECUTIVE PARK ROAD
Second Line : STE 100
City : CONCORD
State : NC
Zip : 28025-1833
Country : US
Telephone Number : 704-939-1100
Fax Number : 704-939-1173
Provider Business Practice Location Address
First Line : 1190 W ROOSEVELT BLVD
Second Line :
City : MONROE
State : NC
Zip : 28110-2818
Country : US
Telephone Number : 704-296-6200
Fax Number : 704-296-4669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 12/20/2024

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