Provider Demographics
NPI:1932300167
Name:REGAN, SHILPA MANGALORE PAI (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:MANGALORE PAI
Last Name:REGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHILPA
Other - Middle Name:MANGALORE
Other - Last Name:PAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:5540 CENTERVIEW DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3363
Mailing Address - Country:US
Mailing Address - Phone:919-424-3827
Mailing Address - Fax:
Practice Address - Street 1:5540 CENTERVIEW DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3363
Practice Address - Country:US
Practice Address - Phone:919-424-3827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046UIOtherPROVIDER NUMBER