Healthcare Provider Details

I. General information

NPI: 1831195692
Provider Name (Legal Business Name): NEENA Y SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4598 S TRACY BLVD C140
TRACY CA
95377-8107
US

IV. Provider business mailing address

11875 DUBLIN BLVD C140
DUBLIN CA
94568-2843
US

V. Phone/Fax

Practice location:
  • Phone: 209-839-1432
  • Fax: 209-839-8681
Mailing address:
  • Phone: 925-587-2500
  • Fax: 925-587-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK6312
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: