Provider Demographics
NPI:1538191507
Name:ESHRAGHI, SHERVIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:
Last Name:ESHRAGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-7224
Mailing Address - Fax:336-718-7598
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-7224
Practice Address - Fax:336-718-7598
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-018042084N0600X, 208M00000X, 2084N0400X
CAA1729412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01804Medicaid
NC5902669Medicaid
NC141PTOtherNCBCBS
NC2049492Medicare PIN
NCI47594Medicare UPIN
NC5902669Medicaid
SCN01804Medicaid