Provider Demographics
NPI:1447793567
Name:MAHTANI, SHARIEN (DO)
Entity Type:Individual
Prefix:
First Name:SHARIEN
Middle Name:
Last Name:MAHTANI
Suffix:
Gender:F
Credentials:DO
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-3050
Mailing Address - Fax:980-302-3055
Practice Address - Street 1:8201 HEALTHCARE LOOP STE 305
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7072
Practice Address - Country:US
Practice Address - Phone:980-302-3050
Practice Address - Fax:980-302-3055
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLU03901207R00000X
NC201700756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine