Provider Demographics
NPI:1245449354
Name:DHIMAN, SHAMLY VENUS (MD)
Entity type:Individual
Prefix:DR
First Name:SHAMLY
Middle Name:VENUS
Last Name:DHIMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAMLY
Other - Middle Name:VENUS
Other - Last Name:AMARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 604350
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-4350
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:1721 EBENEZER RD STE 175
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1188
Practice Address - Country:US
Practice Address - Phone:803-324-5256
Practice Address - Fax:803-328-0440
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40388208600000X
NY244029208600000X
PA437022208600000X
SC33450208600000X
NC2011-00725208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02878908Medicaid
SC33450OtherMEDICAL LICENSE
NC2011-00725OtherMEDICAL LICENSE
NY244029OtherMEDICAL LICENSE
TN40388OtherMEDICAL LICENSE
SC334506Medicaid
NY244029OtherMEDICAL LICENSE
NCFD4288824OtherDEA
SC334506Medicaid