Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 94 01030 | NC |
NPI | 1144204868 |
---|---|
Provider Name | Vandana Shashi |
First Address | Durham, NC 27705-3941 |
Second Address | Durham, NC 27705-3941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 08/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1066W | BCBS (01) | |
176794 | (05) | SC |
2007335000 | (05) | WV |
20290 | PARTNERS (01) | |
370020998 | RR MEDICARE (01) | |
4645029 | AETNA (01) | |
6724779 | (05) | VA |
74315 | MEDCOST (01) | |
891066W | (05) | NC |
G02034 | (02) |