Individual
DR. SHIRISH D DEVASTHALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6387 RAMSEY ST, SUITE 140, FAYETTEVILLE, NC 28311-9441
(910) 615-3829
(910) 615-6216
Mailing address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 615-6949
(910) 615-9761
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
38929
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28386
BCBSNC
NC
01
—
39131
MEDCOST
NC
05
—
8928386
—
NC
Enumeration date
12/19/2006
Last updated
07/10/2014
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