MEDICARE: KHUSHBU RAJESH SHAH AGNP

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	363LA2200X	Adult Health Nurse Practitioner	5020052	NC
2	363L00000X	Nurse Practitioner	5020052	NC

General Provider Information

NPI Number	:	1942060967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHUSHBU RAJESH SHAH AGNP

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14135 BALLANTYNE CORPORATE PL STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-0768
Country	:	US
Telephone Number	:	980-488-9520
Fax Number	:	980-488-9525

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	01/31/2025

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