Provider Demographics
NPI:1467643155
Name:SHAH, NIMESH BHUPENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMESH
Middle Name:BHUPENDRA
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 1:3206 TAYLORSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2965
Mailing Address - Country:US
Mailing Address - Phone:704-873-4000
Mailing Address - Fax:
Practice Address - Street 1:785 US HIGHWAY 70 SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5096
Practice Address - Country:US
Practice Address - Phone:828-437-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA791712084P0800X
NC2004009702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry