Provider Demographics
NPI:1831195692
Name:SHAH, NEENA Y (MD)
Entity type:Individual
Prefix:DR
First Name:NEENA
Middle Name:Y
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11875 DUBLIN BLVD
Mailing Address - Street 2:C140
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2843
Mailing Address - Country:US
Mailing Address - Phone:925-587-2500
Mailing Address - Fax:925-587-2011
Practice Address - Street 1:4598 S TRACY BLVD
Practice Address - Street 2:C140
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8107
Practice Address - Country:US
Practice Address - Phone:209-839-1432
Practice Address - Fax:209-839-8681
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK6312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123727101OtherFIRST CARE PROV NUMBER
TX125863403Medicaid
TX5252625OtherAETNA PROVIDER NUMBER
TX6912142001OtherCIGNA PROVIDER NUMBER
TX181846303OtherUNITED HEALTHCARE PROV NO
TX89110GOtherBCBS PROVIDER NUMBER
TX89751JMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX125863403Medicaid