Provider Demographics
NPI:1265065015
Name:TYAGI, SHUBHAM
Entity type:Individual
Prefix:
First Name:SHUBHAM
Middle Name:
Last Name:TYAGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 CHASEMILL CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8556
Mailing Address - Country:US
Mailing Address - Phone:814-321-1628
Mailing Address - Fax:
Practice Address - Street 1:DUKE URGENT CARE BRIER CREEK
Practice Address - Street 2:10211 ALM STREET SUITE 1200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-2761
Practice Address - Country:US
Practice Address - Phone:814-321-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily