Individual provider Active NPI

Shreni Nilesh Shah, MD

  • Otolaryngology Physician
  • Charleston, SC
National Provider Identifier
1861122905
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
LL88153 Issued in SC
Practice address
135 Rutledge Ave Ste 1130
Charleston, SC 29425-8905
Phone
(843) 876-0791
NPI assigned
Jun 13, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X LL88153 SC Primary

Addresses

Primary practice location

135 Rutledge Ave Ste 1130
Charleston, SC 29425-8905

Mailing address

169 Ashley Ave RM 202
Charleston, SC 29425-8905
Phone (843) 876-0791

Other practice location 1

169 Ashley Ave Rm 202
Charleston, SC 29425-8905
Phone (843) 876-0791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221201003192 SC Order and Referring Only - OtolaryngologyPractitioner - Otolaryngology 1052789617

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1861122905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE RM 202",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-876-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 RUTLEDGE AVE STE 1130",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-876-0791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "169 Ashley Ave Rm 202",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258905",
            "country_code": "US",
            "telephone_number": "843-876-0791",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SHRENI",
        "middle_name": "NILESH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-13",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "SC",
            "license": "LL88153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.