Basic Information
| Provider Information | |||||||||
| NPI: | 1720231749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHANTI | ||||||||
| FirstName: | NAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 PERIMETER PARK DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275608442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9842154110 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1110 SE CARY PKWY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275187420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192970000 | ||||||||
| FaxNumber: | 9192325328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2008 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35-095831 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 44010 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 2013-01658 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 201006210 | 05 | IN | MEDICAID | 7100103970 | 05 | KY | MEDICAID | 3079823 | 05 | OH | MEDICAID |