Healthcare Provider Details

I. General information

NPI: 1093228280
Provider Name (Legal Business Name): SORAYA SHAH CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SILVER BUCKLE RD
SANTA FE NM
87508-1491
US

IV. Provider business mailing address

HC 72 BOX 18
RIBERA NM
87560-9601
US

V. Phone/Fax

Practice location:
  • Phone: 206-719-1959
  • Fax:
Mailing address:
  • Phone: 206-719-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number17172R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: