Individual
LISA S SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
454 ST MICHAELS DR STE 200, FAMILY MEDICINE, SANTA FE, NM 87505-7602
(505) 303-5000
(505) 303-5202
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2026-0033
NM
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/09/2022
Last updated
04/30/2026
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