Provider Demographics
NPI:1912465311
Name:SHIVAG DIABETIC SHOES AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:SHIVAG DIABETIC SHOES AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENAYSWHARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-200-7950
Mailing Address - Street 1:3100 DURALEIGH RD STE 207
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8106
Mailing Address - Country:US
Mailing Address - Phone:984-200-7950
Mailing Address - Fax:984-200-8370
Practice Address - Street 1:3100 DURALEIGH RD STE 207
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:984-200-7950
Practice Address - Fax:984-200-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies