MEDICARE: NARENDRA C SHAH MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1154428209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NARENDRA C SHAH MD PC

Provider Business Mailing Address
First Line	:	PO BOX 4127
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-0127
Country	:	US
Telephone Number	:	540-981-9344
Fax Number	:	540-344-9779

Provider Business Practice Location Address
First Line	:	1310 MAPLE AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-4914
Country	:	US
Telephone Number	:	540-345-8332
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NARENDRA C SHAH
Credential	:	MD
Telephone Number	:	540-344-7154

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/18/2011

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