1811933666 NPI number — DR. MUNIZA SHAH M.D.

Table of content: DR. MUNIZA SHAH M.D. (NPI 1811933666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811933666 NPI number — DR. MUNIZA SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
MUNIZA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811933666
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4379 EASTON AVE STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18020-1483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-564-1205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4379 EASTON AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18020-1483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-564-1205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  01056023A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: MD437682 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD437682 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000244420 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01056023B . This is a "CSR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 01056023A . This is a "MAGELLAN BEHAVIORAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200409990 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418373 . This is a "VALUE OPTIONS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 117910800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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