Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 2012-00034 | NC |
NPI | 1275790495 |
---|---|
Provider Name | Mila D Shah-Bruce |
First Address | Sylva, NC 28779-2742 |
Second Address | Sylva, NC 28779-2742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2008 |
Last Update Date | 05/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275790495 | (05) | NC |