Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | PENDING | KY |
N | 111NI0900X | Internist | PENDING | KY |
Y | 207RR0500X | Rheumatology | 300501 | LA |
N | 207RR0500X | Rheumatology | N1445 | TX |
NPI | 1003090663 |
---|---|
Provider Name | Mansi Shah |
First Address | Shreveport, LA 71105-5634 |
Second Address | Shreveport, LA 71105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2409051 | (05) | LA |