Provider Demographics
NPI:1699827733
Name:GOSRANI, SHILPA NIMISH (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHILPA
Middle Name:NIMISH
Last Name:GOSRANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-272-9447
Mailing Address - Fax:336-272-2112
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-272-9447
Practice Address - Fax:336-272-2112
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800786208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891160WMedicaid
I42322Medicare UPIN