Basic Information
Provider Information | |||||||||
NPI: | 1699195867 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DARJI | ||||||||
FirstName: | UMA | ||||||||
MiddleName: | SUNNY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SHAH | ||||||||
OtherFirstName: | UMA | ||||||||
OtherMiddleName: | UDAY | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2412 WILKINS DR | ||||||||
Address2: |   | ||||||||
City: | SANFORD | ||||||||
State: | NC | ||||||||
PostalCode: | 273307268 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197766000 | ||||||||
FaxNumber: | 9197760130 | ||||||||
Practice Location | |||||||||
Address1: | 2412 WILKINS DR | ||||||||
Address2: |   | ||||||||
City: | SANFORD | ||||||||
State: | NC | ||||||||
PostalCode: | 27330 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197766000 | ||||||||
FaxNumber: | 9197760130 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/25/2014 | ||||||||
LastUpdateDate: | 04/12/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2017-01800 | NC | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 19R2W | 01 | NC | BCBS OF NC | OTHER | 1699195867 | 05 | NC |   | MEDICAID | NCY782A | 01 | NC | MEDICARE | OTHER |