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General NPI Number Information
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NPI Number | 1760578033
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Entity Type | Individual
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Provider Name | SHAISTA I SHAH MD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6250 THORNTON AVE
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City | NEWARK
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State | CA
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Zip | 94560-3747
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Country | US
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Telephone | 510-791-1798
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Fax | 510-791-1347
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Provider Business Mailing Address
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Address Line | 2333 MOWRY AVE SUITE 300
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City | FREMONT
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State | CA
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Zip | 94538
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Country | US
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Telephone | 510-796-0222
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Fax | 510-796-7760
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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 | A94712
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License Number State | CA
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