Individual
AMITA SADASHIV SHETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3308 MELROSE RD, FAYETTEVILLE, NC 28304-1604
(910) 615-3200
(910) 615-3201
Mailing address
1638 OWEN DR, ATTN: MANAGED CARE PLANNING, FAYETTEVILLE, NC 28304-3424
(910) 615-6949
(910) 615-9761
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
009700753
NC
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
9700753
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1173E
BCBS
NC
05
—
891173E
—
NC
Enumeration date
06/30/2005
Last updated
08/18/2025
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