Provider Demographics
NPI:1972484715
Name:SHAH, STEPHANIE DORTHEA (DDIV)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DORTHEA
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:HOLLY GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72069-0193
Mailing Address - Country:US
Mailing Address - Phone:870-468-6358
Mailing Address - Fax:
Practice Address - Street 1:185 SOUTH SMITH STREET
Practice Address - Street 2:
Practice Address - City:HOLLY GROVE
Practice Address - State:AR
Practice Address - Zip Code:72069-0193
Practice Address - Country:US
Practice Address - Phone:870-468-6358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath