Provider Demographics
NPI:1356677314
Name:SHAH, PRITI (MS, CCC)
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 VINEYARD DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-8246
Mailing Address - Country:US
Mailing Address - Phone:805-428-1997
Mailing Address - Fax:805-306-0902
Practice Address - Street 1:517 VINEYARD DR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-8246
Practice Address - Country:US
Practice Address - Phone:805-428-1997
Practice Address - Fax:805-306-0902
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 11055235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist