Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | E-13415 | AR |
NPI | 1154852499 |
---|---|
Provider Name | Shami Nandy |
First Address | North Little Rock, AR 72114-1709 |
Second Address | North Little Rock, AR 72114-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2017 |
Last Update Date | 23/05/2021 |