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Individual

NANDINI SHAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
9555 76TH STREET, PLEASANT PRAIRIE, WI 53158
(262) 577-8300
Mailing address
9555 76TH STREET, PLEASANT PRAIRIE, WI 53158

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35252
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080171366
MEDICARE RR
WI
05
32100900
WI
01
338121367001
ANTHEM
WI
Enumeration date
07/11/2006
Last updated
03/14/2008
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