Provider Demographics
NPI:1972530368
Name:SHAH, SUMATI B (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMATI
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3318 HEALY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1404
Mailing Address - Country:US
Mailing Address - Phone:336-768-3530
Mailing Address - Fax:336-768-1329
Practice Address - Street 1:3318 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1404
Practice Address - Country:US
Practice Address - Phone:336-768-3530
Practice Address - Fax:336-768-1329
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC22664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine