Provider Demographics
NPI:1407211287
Name:SHAH, JULIANA M (APNP)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:M
Other - Last Name:PIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7080 N PORT WASHINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:414-351-4009
Mailing Address - Fax:414-351-7060
Practice Address - Street 1:7080 N PORT WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217
Practice Address - Country:US
Practice Address - Phone:414-351-4009
Practice Address - Fax:414-351-7060
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6715 - 33363LP2300X
WI6715-33207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1407211287Medicaid