Provider Demographics
NPI:1245042274
Name:SHAH, SHRUTI S (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 E CARMEL DR # 468
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2812
Mailing Address - Country:US
Mailing Address - Phone:463-293-0466
Mailing Address - Fax:
Practice Address - Street 1:950 PARK EAST BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0792
Practice Address - Country:US
Practice Address - Phone:765-447-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016249A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily