Individual
JAVED MIYA SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
895 LAKLOEY DR, NORTH POLE, AK 99705-5355
(347) 613-3376
Mailing address
1825 MARIKA RD, FAIRBANKS, AK 99709-5521
(907) 474-0890
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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