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NPI Code Detail

MEDICARE: LAYLA SHANAH

MEDICARE: LAYLA SHANAH
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine Physician01088217AIN

General Provider Information

NPI Number : 1457619397
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAYLA SHANAH
Provider Business Mailing Address
First Line : 8050 TOWNSHIP LINE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2478
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8050 TOWNSHIP LINE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2478
Country : US
Telephone Number : 317-415-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2012
Last Update Date : 08/22/2022

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Directions to “ LAYLA SHANAH ” Practice Location

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