Provider Demographics
NPI:1588954457
Name:SHAH, NEIL DEVENDRA (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:DEVENDRA
Last Name:SHAH
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 1:8009 BURNETT WOMACK BUILDING CB# 7584
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7584
Mailing Address - Country:US
Mailing Address - Phone:919-966-2516
Mailing Address - Fax:984-974-3414
Practice Address - Street 1:130 MASON FARM RD
Practice Address - Street 2:4119B BIOINFORMATICS
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599
Practice Address - Country:US
Practice Address - Phone:919-966-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254535207R00000X
NC198451207R00000X
TN56024207R00000X, 207RG0100X
390200000X
NC2014-01118207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program