Healthcare Provider Details

I. General information

NPI: 1750164778
Provider Name (Legal Business Name): SHAH & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HOSPITAL RD STE 300
PRINCE FREDERICK MD
20678-4057
US

IV. Provider business mailing address

PO BOX 603
LEONARDTOWN MD
20650-0603
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4333
  • Fax: 410-535-3260
Mailing address:
  • Phone: 301-475-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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