Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | E-13342 | AR |
N | 111NI0900X | Internist | E-13342 | AR |
N | 207RC0000X | Internist - Cardiovascular Disease | E-13342 | AR |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | E-13342 | AR |
NPI | 1154634095 |
---|---|
Provider Name | Sanjay D Shah |
First Address | Little Rock, AR 72225-1420 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2010 |
Last Update Date | 24/11/2020 |