Provider Demographics
NPI:1174503296
Name:SHAH, CARMELITA (MD)
Entity Type:Individual
Prefix:
First Name:CARMELITA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 67TH ST UNIT 315
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2425
Mailing Address - Country:US
Mailing Address - Phone:515-771-0668
Mailing Address - Fax:
Practice Address - Street 1:345 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:IA
Practice Address - Zip Code:50682-0130
Practice Address - Country:US
Practice Address - Phone:319-935-3343
Practice Address - Fax:319-935-3331
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23149208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0218313Medicaid
IA0218313Medicaid