Provider Demographics
NPI:1811933666
Name:SHAH, MUNIZA (MD)
Entity type:Individual
Prefix:DR
First Name:MUNIZA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4379 EASTON AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-1483
Mailing Address - Country:US
Mailing Address - Phone:260-564-1205
Mailing Address - Fax:
Practice Address - Street 1:4379 EASTON AVE STE 110
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1483
Practice Address - Country:US
Practice Address - Phone:260-564-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056023A2084P0800X
PAMD4376822084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000244420OtherANTHEM BLUE CROSS BLUE SH
IN01056023BOtherCSR
IN01056023AOtherMAGELLAN BEHAVIORAL
IN200409990Medicaid
IN418373OtherVALUE OPTIONS
IN418373OtherVALUE OPTIONS
INBS6608092OtherDEA
INH11374Medicare UPIN
INP00034151Medicare UPIN