Provider Demographics
NPI:1851683726
Name:SHAH, LEAH ANNE (OTR)
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:ANNE
Last Name:SHAH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BROADMOOR RD #215
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:UM
Mailing Address - Phone:512-992-5354
Mailing Address - Fax:
Practice Address - Street 1:1201 BROADMOOR DR APT 215
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3113
Practice Address - Country:US
Practice Address - Phone:512-992-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112719174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist