Healthcare Provider Details

I. General information

NPI: 1316506850
Provider Name (Legal Business Name): AAYUSHMA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 WALLACE AVE STE 101
LEITCHFIELD KY
42754-2405
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-259-9316
  • Fax: 270-259-6571
Mailing address:
  • Phone: 270-688-1330
  • Fax: 270-688-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56481
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: