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General NPI Number Information
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NPI Number | 1174503296
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Entity Type | Individual
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Provider Name | CARMELITA SHAH M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 345 1ST ST S
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City | WINTHROP
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State | IA
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Zip | 50682-0130
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Country | US
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Telephone | 319-935-3343
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Fax | 319-935-3331
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Provider Business Mailing Address
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Address Line | 950 67TH ST UNIT 315
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City | WEST DES MOINES
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State | IA
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Zip | 50266-2425
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Country | US
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Telephone | 515-771-0668
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 23149
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 23149
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License Number State | IA
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