Healthcare Provider Details

I. General information

NPI: 1093546426
Provider Name (Legal Business Name): HIMJA V. SHAH CRNP-OB/GYN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY STE 310
ANNAPOLIS MD
21401-3754
US

IV. Provider business mailing address

689 RAVENWOOD DR
GLEN BURNIE MD
21060-7592
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-7755
  • Fax: 410-266-1141
Mailing address:
  • Phone: 433-845-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR226816
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: