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General NPI Number Information
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NPI Number | 1003951187
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Entity Type | Individual
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Provider Name | LISA SHAH DPM
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 52 DUANE ST
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City | NEW YORK
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State | NY
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Zip | 10007-1207
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Country | US
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Telephone | 212-349-7676
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Fax | 212-349-1882
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Provider Business Mailing Address
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Address Line | 6 WIMBLEDON CT
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City | WHITE PLAINS
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State | NY
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Zip | 10607-1634
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Country | US
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Telephone | 646-831-5784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N005855
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N005855
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License Number State | NY
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