Provider Demographics
NPI:1760772768
Name:MAGO-SHAH, DEESHA DHAVAL (MD)
Entity Type:Individual
Prefix:
First Name:DEESHA
Middle Name:DHAVAL
Last Name:MAGO-SHAH
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 1:70 SCOTTISH LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5294
Mailing Address - Country:US
Mailing Address - Phone:410-608-8064
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY HOSPITAL
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-5294
Practice Address - Country:US
Practice Address - Phone:919-681-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program