Provider Demographics
NPI:1720231749
Name:SHANTI, NAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NAEL
Middle Name:
Last Name:SHANTI
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 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4110
Mailing Address - Fax:
Practice Address - Street 1:1110 SE CARY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7420
Practice Address - Country:US
Practice Address - Phone:919-297-0000
Practice Address - Fax:919-232-5328
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-095831207X00000X
KY44010207X00000X
NC2013-01658207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201006210Medicaid
KY7100103970Medicaid
OH3079823Medicaid
IN201006210Medicaid
OH4305811Medicare PIN
KYK001290Medicare PIN
KY7100103970Medicaid