Healthcare Provider Details

I. General information

NPI: 1073018693
Provider Name (Legal Business Name): ISMA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 CENTRE RD STE 200
WILMINGTON DE
19805-1266
US

IV. Provider business mailing address

700 PRIDES XING STE 200
NEWARK DE
19713-6109
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-0300
  • Fax:
Mailing address:
  • Phone: 302-998-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.246576
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC7-0017584
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC1-0026411
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: