Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | BP10052648 | TX |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD198475 | OR |
NPI | 1023498276 |
---|---|
Provider Name | Suparna N Shah |
First Address | Galveston, TX 77555-0521 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 04/06/2020 |