Provider Demographics
NPI:1093228280
Name:SHAH, SORAYA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 72 BOX 18
Mailing Address - Street 2:
Mailing Address - City:RIBERA
Mailing Address - State:NM
Mailing Address - Zip Code:87560-9601
Mailing Address - Country:US
Mailing Address - Phone:206-719-1959
Mailing Address - Fax:
Practice Address - Street 1:7 SILVER BUCKLE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-1491
Practice Address - Country:US
Practice Address - Phone:206-719-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM17172R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife