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General NPI Number Information
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NPI Number | 1417454075
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Entity Type | Individual
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Provider Name | NEIL SHAH
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Gender | Male
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 09/03/2024
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Provider Practice Location Address
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Address Line | 3805 MCCAIN PARK DR STE 104
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7813
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Country | US
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Telephone | 501-414-6753
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Fax | 501-209-4205
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Provider Business Mailing Address
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Address Line | 5158 CLARETON DR UNIT 1602
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City | AGOURA HILLS
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State | CA
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Zip | 91376-7086
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A164760
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License Number State | CA
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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 | A164760
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | E-14796
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License Number State | AR
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