Provider Demographics
NPI:1679561369
Name:SHAH, PRIYAVADAN MANEKLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYAVADAN
Middle Name:MANEKLAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 KEISLER DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-7083
Mailing Address - Country:US
Mailing Address - Phone:919-233-0059
Mailing Address - Fax:919-233-0343
Practice Address - Street 1:300 KEISLER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7083
Practice Address - Country:US
Practice Address - Phone:919-233-0059
Practice Address - Fax:919-233-0343
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC25079207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75390OtherNC BLUE CROSS BLUE SHIELD
110004188OtherRAILROAD MEDICARE
30583OtherMEDCOST
NC8975390Medicaid
761782OtherCIGNA HEALTHCARE
2550135OtherUNITED HEALTHCARE
NC8975390Medicaid