Healthcare Provider Details

I. General information

NPI: 1912770660
Provider Name (Legal Business Name): HELY SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DRIVE STE 207
UKIAH CA
95482
US

IV. Provider business mailing address

357 YOLANDA AVE APT 308
SANTA ROSA CA
95404-6458
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-7627
  • Fax: 707-463-7420
Mailing address:
  • Phone: 650-304-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number191965
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number191965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: