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General NPI Number Information
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NPI Number | 1477696193
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Entity Type | Individual
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Provider Name | SVETLANA CLARAVALL SHAH MD
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Gender | Female
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 11050 MT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-2603
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Country | US
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Telephone | 315-772-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 22220 RIVERGLADE DR
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City | WATERTOWN
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State | NY
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Zip | 13601-1773
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Country | US
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Telephone | 405-517-2478
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 268281
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24607
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License Number State | OK
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