Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 61181 | WI |
N | 207VE0102X | Reproductive Endocrinologist | E-4206 | AR |
NPI | 1023108511 |
---|---|
Provider Name | Aida Shanti |
First Address | West Allis, WI 53227-2409 |
Second Address | West Allis, WI 53227-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
154646001 | (05) | AR |
F27417 | (02) |