Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | R03928 | LA |
NPI | 1336261635 |
---|---|
Provider Name | Dr. Sangeeta A Shah |
First Address | Lafayette, LA 70508-7018 |
Second Address | Lafayette, LA 70508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |