Healthcare Provider Details

I. General information

NPI: 1174503296
Provider Name (Legal Business Name): CARMELITA SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 1ST ST S
WINTHROP IA
50682-0130
US

IV. Provider business mailing address

950 67TH ST UNIT 315
WEST DES MOINES IA
50266-2425
US

V. Phone/Fax

Practice location:
  • Phone: 319-935-3343
  • Fax: 319-935-3331
Mailing address:
  • Phone: 515-771-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23149
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23149
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: