Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 2005-01544 | NC |
NPI | 1114012341 |
---|---|
Provider Name | Mrs. Cynthia K Shortell |
First Address | Durham, NC 27713-4430 |
Second Address | Durham, NC 27710-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 12/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5902492 | (05) | NC |
F54997 | (02) | NC |