Healthcare Provider Details

I. General information

NPI: 1831364363
Provider Name (Legal Business Name): MAHIM SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SE 172ND AVE
VANCOUVER WA
98684-9542
US

IV. Provider business mailing address

8706 N FARRELL ST
CAMAS WA
98607-0599
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax: 360-604-1771
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.MD70109985
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNCBH-S02
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD436977
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: