MEDICARE: KENA SHAH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	90061	SC
2	207K00000X	Allergy & Immunology Physician	37400027	NC

General Provider Information

NPI Number	:	1356604169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENA SHAH D.O.

Provider Business Mailing Address
First Line	:	PO BOX 63376
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28263-2012
Country	:	US
Telephone Number	:	704-372-7900
Fax Number	:	704-376-2216

Provider Business Practice Location Address
First Line	:	2600 E 7TH ST UNIT A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4398
Country	:	US
Telephone Number	:	704-372-7900
Fax Number	:	704-376-2216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	01/17/2024

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