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General NPI Number Information
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NPI Number | 1457164923
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Entity Type | Organization
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Legal Business Name | SHAH DERMATOLOGY LLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 22590 SHADY CT
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City | CALIFORNIA
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State | MD
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Zip | 20619-5009
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Country | US
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Telephone | 301-994-8010
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Fax | 301-373-9197
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | HOLLYWOOD
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State | MD
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Zip | 20636-0640
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Country | US
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Telephone | 301-994-8010
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MELISSA NORRIS
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Credential |
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Telephone | 301-373-7318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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