Healthcare Provider Details

I. General information

NPI: 1184870958
Provider Name (Legal Business Name): NAMRATA SAMIR SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE. STE. L400
MEMPHIS TN
38103
US

IV. Provider business mailing address

850 POPLAR AVE BLDG. 2
MEMPHIS TN
38105
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-7337
  • Fax: 901-287-4540
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number43588
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: