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General NPI Number Information
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NPI Number | 1497108062
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Entity Type | Individual
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Provider Name | PALVASHA SHAH MD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 600 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone | 209-569-7408
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Fax | 209-569-7778
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Provider Business Mailing Address
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Address Line | 10470 OLD PLACERVILLE RD STE 100
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City | SACRAMENTO
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State | CA
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Zip | 95827-2539
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Country | US
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Telephone | 800-471-0071
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Fax | 209-468-7042
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A159664
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License Number State | CA
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