Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 11019501A | IN |
Y | 111NI0900X | Internist | 11019501A | IN |
NPI | 1003346644 |
---|---|
Provider Name | Dr. Mesha M Shaw |
First Address | Indianapolis, IN 46202-5209 |
Second Address | Indianapolis, IN 46202-5209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 15/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11019501A | INDIANA PROFESSIONAL LICENSING AGENCY (01) | IN |