Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 285802 | MA |
NPI | 1033504394 |
---|---|
Provider Name | Dr. Priyanca Shah |
First Address | Charlestown, MA 02129-3109 |
Second Address | Charlestown, MA 02129-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 06/11/2020 |