Provider Demographics
NPI:1851450886
Name:SHAH, SANJAY (PT)
Entity Type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ANNANDALE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6502
Mailing Address - Country:US
Mailing Address - Phone:919-851-1164
Mailing Address - Fax:919-851-1196
Practice Address - Street 1:519 KEISLER DR. STE# 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7098
Practice Address - Country:US
Practice Address - Phone:919-851-1164
Practice Address - Fax:919-851-1196
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078M2OtherBCBS
NC7211310Medicaid
NC7211310Medicaid