Healthcare Provider Details

I. General information

NPI: 1669686432
Provider Name (Legal Business Name): SHAH & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/10/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26840 POINT LOOKOUT ROAD
LEONARDTOWN MD
20650
US

IV. Provider business mailing address

PO BOX 603
LEONARDTOWN MD
20650-0603
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-5577
  • Fax: 301-373-6900
Mailing address:
  • Phone: 301-475-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DIPAK SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 301-475-5577