Healthcare Provider Details

I. General information

NPI: 1336261635
Provider Name (Legal Business Name): SANGEETA A SHAH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 KALISTE SALOOM RD
LAFAYETTE LA
70508
US

IV. Provider business mailing address

114 ISLAND PT
LAFAYETTE LA
70508-7018
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-1166
  • Fax: 337-235-1168
Mailing address:
  • Phone: 337-981-7205
  • Fax: 337-235-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberR03928
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: