Provider Demographics
NPI:1598708976
Name:SHAH, NAYANA (MD)
Entity Type:Individual
Prefix:DR
First Name:NAYANA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAYANA
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16152 BEACH BLVD
Mailing Address - Street 2:200
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:714-841-6772
Mailing Address - Fax:714-841-6775
Practice Address - Street 1:16152 BEACH BLVD
Practice Address - Street 2:200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92630
Practice Address - Country:US
Practice Address - Phone:714-841-6772
Practice Address - Fax:714-841-6775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA375302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA375301Medicaid
CAA37530Medicare ID - Type Unspecified
C66984Medicare UPIN