Provider Demographics
NPI:1407990187
Name:SHAH, VARSHA PIYUSH (MA)
Entity Type:Individual
Prefix:MRS
First Name:VARSHA
Middle Name:PIYUSH
Last Name:SHAH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 E MALLORY ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-1328
Mailing Address - Country:US
Mailing Address - Phone:480-464-1095
Mailing Address - Fax:
Practice Address - Street 1:4825 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5917
Practice Address - Country:US
Practice Address - Phone:602-629-6450
Practice Address - Fax:602-629-6470
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0562225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ640666Medicaid