Healthcare Provider Details

I. General information

NPI: 1023614625
Provider Name (Legal Business Name): POOJA SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 ULMERTON RD STE B-3
LARGO FL
33771-3530
US

IV. Provider business mailing address

10427 ULMERTON RD STE B-3
LARGO FL
33771-3530
US

V. Phone/Fax

Practice location:
  • Phone: 737-535-9993
  • Fax:
Mailing address:
  • Phone: 727-535-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH26594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: