Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | C10008212 | DE |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD061646L | PA |
N | 207YP0228X | Pediatric Otolaryngology | C10008212 | DE |
NPI | 1386734317 |
---|---|
Provider Name | Udayan K Shah |
First Address | Rockland, DE 19723-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 04/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001697070 | (05) | PA |
001698095 | (05) | PA |
4126190 | (05) | MD |
7562101 | (05) | NJ |
H25329 | (02) | PA |