Healthcare Provider Details

I. General information

NPI: 1255902789
Provider Name (Legal Business Name): BHUMIKA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 ASHLAND AVE RM 646
BALTIMORE MD
21205-1531
US

IV. Provider business mailing address

1741 ASHLAND AVE RM 646
BALTIMORE MD
21205-1531
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9200
  • Fax:
Mailing address:
  • Phone: 443-923-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0105757
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: