Provider Demographics
NPI:1568935336
Name:SHAH, SERENA ANITA (ATC)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:ANITA
Last Name:SHAH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MILLSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8873
Mailing Address - Country:US
Mailing Address - Phone:919-880-3456
Mailing Address - Fax:
Practice Address - Street 1:1000 POWELL MILL RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5808
Practice Address - Country:US
Practice Address - Phone:864-587-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program