Provider Demographics
NPI:1295788990
Name:DEVESHWAR, SHAILI (MD)
Entity type:Individual
Prefix:
First Name:SHAILI
Middle Name:
Last Name:DEVESHWAR
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:PO BOX 745040
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1313 CAROLINA ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6002
Practice Address - Country:US
Practice Address - Phone:336-235-4372
Practice Address - Fax:336-235-4381
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000769207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127R3Medicaid
NC89127R3Medicaid
NC2280940Medicare PIN