Provider Demographics
NPI:1720889405
Name:GHOSH, SHABORI
Entity type:Individual
Prefix:
First Name:SHABORI
Middle Name:
Last Name:GHOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CLANCY CIR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5577
Mailing Address - Country:US
Mailing Address - Phone:704-236-0732
Mailing Address - Fax:
Practice Address - Street 1:919 KILDAIRE FARM RD STE G2-B
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3935
Practice Address - Country:US
Practice Address - Phone:919-871-4571
Practice Address - Fax:919-467-6166
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20756225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist