Provider Demographics
NPI:1205995958
Name:SHAH, SELINA (MD)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:2255 YGNACIO VALLEY RD STE V
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3343
Mailing Address - Country:US
Mailing Address - Phone:925-979-5327
Mailing Address - Fax:925-357-3199
Practice Address - Street 1:2255 YGNACIO VALLEY RD STE V
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3343
Practice Address - Country:US
Practice Address - Phone:925-979-5327
Practice Address - Fax:925-357-3199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83067207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83067OtherMEDICAL LICENSE