=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669180204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHREYA SHAH DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2022
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 W LAYTON AVE STE 305
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53207-5941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-539-4005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 N BLUESPRUCE CIR
-----------------------------------------------------
City | HARTLAND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53029-8681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6001438-15
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------