Healthcare Provider Details

I. General information

NPI: 1912338310
Provider Name (Legal Business Name): URVI SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-4288
  • Fax: 505-275-4203
Mailing address:
  • Phone: 505-262-7215
  • Fax: 505-232-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2015-0356
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2017-0249
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: