Healthcare Provider Details

I. General information

NPI: 1841268414
Provider Name (Legal Business Name): NEENA D SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S HAMILTON ST
MADISON WI
53703-4314
US

IV. Provider business mailing address

117 S HAMILTON ST
MADISON WI
53703-4314
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number47692
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: