Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 69387 | WI |
Y | 2080P0203X | Pediatric Critical Care Doctor | A-2496-21 | NM |
NPI | 1154715639 |
---|---|
Provider Name | Palak Shah |
First Address | Albuquerque, NM 87106-4934 |
Second Address | Albuquerque, NM 87106-4934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 24/12/2021 |