Provider Demographics
NPI:1528222569
Name:SHAH, PAYAL MITESH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:MITESH
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAYAL
Other - Middle Name:KIRAN
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16830 NORTHUP WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-3048
Mailing Address - Country:US
Mailing Address - Phone:404-751-6666
Mailing Address - Fax:253-216-2818
Practice Address - Street 1:1314 CENTRAL AVE S STE 102
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7430
Practice Address - Country:US
Practice Address - Phone:253-397-8683
Practice Address - Fax:855-853-7278
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 194034207Q00000X
WAMD60191665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine