Healthcare Provider Details

I. General information

NPI: 1104409846
Provider Name (Legal Business Name): CHARUL SHAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BLAKE WILBUR DR
PALO ALTO CA
94304-2205
US

IV. Provider business mailing address

1976 BADGERWOOD LN
MILPITAS CA
95035-2544
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-1860
  • Fax:
Mailing address:
  • Phone: 408-956-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number676060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: