Healthcare Provider Details

I. General information

NPI: 1417388711
Provider Name (Legal Business Name): NAURA SHAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 10/29/2026
Certification Date: 10/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 YGNACIO VALLEY RD STE B1
WALNUT CREEK CA
94598-3335
US

IV. Provider business mailing address

370 N WIGET LN
WALNUT CREEK CA
94598-2488
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-7005
  • Fax:
Mailing address:
  • Phone: 925-945-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number65615
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: