Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 275649 | NY |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 271817 | MA |
NPI | 1023367885 |
---|---|
Provider Name | Tishi S Shah |
First Address | Boston, MA 02111-1552 |
Second Address | Boston, MA 02111-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 05/09/2017 |