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NPI Code Detail

MEDICARE: SUSMITA S. SHAH MFT

MEDICARE: SUSMITA S. SHAH MFT
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
1106H00000XMarriage & Family TherapistMFC 47452CA

General Provider Information

NPI Number : 1952458879
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSMITA S. SHAH MFT
Provider Business Mailing Address
First Line : 1944 FILLMORE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-2745
Country : US
Telephone Number : 415-305-1493
Fax Number :
Provider Business Practice Location Address
First Line : 1944 FILLMORE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94115-2745
Country : US
Telephone Number : 415-305-1493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 11/05/2010

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