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General NPI Number Information
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NPI Number | 1174282149
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Entity Type | Individual
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Provider Name | SHRUTI SHAH FNP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 4401 ATLANTIC AVE STE 110
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City | LONG BEACH
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State | CA
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Zip | 90807-2254
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Country | US
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Telephone | 440-575-0107
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Fax | 888-826-1516
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Provider Business Mailing Address
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Address Line | 27991 CENTER RIDGE RD
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City | WESTLAKE
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State | OH
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Zip | 44145-3902
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Country | US
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Telephone | 440-575-0107
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Fax | 888-826-1516
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95019071
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License Number State | CA
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