Basic Information
| Provider Information | |||||||||
| NPI: | 1689967440 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHAH-JADEJA | ||||||||
| FirstName: | MANSI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNC HOSPITALS DEPT OF SURGERY | ||||||||
| Address2: | 101 MANNING DR. CB#7050 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664653 | ||||||||
| FaxNumber: | 9199667841 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF KENTUCKY | ||||||||
| Address2: | 740 SOUTH LIMESTONE, ROOM A301 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235057 | ||||||||
| FaxNumber: | 8592574682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2014-02438 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 51578 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.