MEDICARE: SHIVANG SHAH

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
1	183500000X	Pharmacist	30800	NC

General Provider Information

NPI Number	:	1790452662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVANG SHAH

Provider Business Mailing Address
First Line	:	2021 MORTON ST APT 524
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5495
Country	:	US
Telephone Number	:	540-580-7532
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 MORTON ST APT 524
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5495
Country	:	US
Telephone Number	:	540-580-7532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	08/27/2021

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Directions to “ SHIVANG SHAH ” Practice Location

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