Provider Demographics
NPI:1992150189
Name:MORADIA, NISHIKA SHINA
Entity type:Individual
Prefix:
First Name:NISHIKA
Middle Name:SHINA
Last Name:MORADIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NISHIKA
Other - Middle Name:SHINA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 BLUE RIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6476
Mailing Address - Country:US
Mailing Address - Phone:919-784-7874
Mailing Address - Fax:
Practice Address - Street 1:2800 BLUE RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6476
Practice Address - Country:US
Practice Address - Phone:919-784-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2023-02196208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program