Provider Demographics
NPI:1891540290
Name:SHAH, PRITI (DR)
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 HENDERSON LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5207
Mailing Address - Country:US
Mailing Address - Phone:865-617-4428
Mailing Address - Fax:
Practice Address - Street 1:1022 HENDERSON LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-5207
Practice Address - Country:US
Practice Address - Phone:865-617-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist