Provider Demographics
NPI:1851525455
Name:NEWAZ, SHAH
Entity Type:Individual
Prefix:
First Name:SHAH
Middle Name:
Last Name:NEWAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHAH
Other - Middle Name:
Other - Last Name:NEWAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:19711 BLYTHE ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2319
Mailing Address - Country:US
Mailing Address - Phone:818-903-7424
Mailing Address - Fax:
Practice Address - Street 1:8660 WOODLEY AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5745
Practice Address - Country:US
Practice Address - Phone:818-894-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2638225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist