Individual
ANITA SHIVADAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5832 FAYETTEVILLE RD, SUITE 113, DURHAM, NC 27713-6290
(919) 544-6644
(919) 544-0934
Mailing address
5213 S ALSTON AVE, DURHAM, NC 27713-4430
(919) 620-4917
(919) 620-4921
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
201001362
NC
207R00000X
Internal Medicine Physician
2010-01362
NC
207R00000X
Internal Medicine Physician
Primary
35087481
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166560
NC LICENSE
NC
05
—
2654686
—
OH
Enumeration date
05/25/2006
Last updated
12/15/2010
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